Fortescue et al developed a risk score for predicting acute renal failure (ARF) following coronary artery bypass graft (CABG) surgery. The score is based on a study from the VA Continuous Improvement in Cardiac Surgery Program (CICSP). The authors are from Brigham and Women's Hospital and the University of California San Francisco.
Parameters:
(1) creatinine clearance
(2) intra-aortic balloon pump (IABP) inserted prior to surgery
(3) systolic blood pressure
(4) valvular surgery
(5) prior heart surgery
(6) NYHA functional status
(7) peripheral vascular disease
(8) left ventricular ejection fraction (LVEF)
(9) pulmonary rales (CHF)
(10) chronic obstructive pulmonary disease (COPD)
|
Parameter |
Finding |
Points |
|
creatinine clearance |
>= 100 mL per min |
0 |
|
|
80 - 99 |
2 |
|
|
60 - 79 |
3 |
|
|
40 - 59 |
5 |
|
|
< 40 |
9 |
|
IABP |
absent |
0 |
|
|
present |
5 |
|
systolic blood pressure |
>= 120 mm Hg AND CABG |
3 |
|
|
< 120 mm Hg AND valvular surgery |
2 |
|
|
else |
0 |
|
valvular surgery |
absent |
0 |
|
|
present |
3 |
|
history of prior heart surgery |
absent |
0 |
|
|
present |
3 |
|
NYHA |
class I, II or III |
0 |
|
|
class IV |
2 |
|
peripheral vascular disease |
absent |
0 |
|
|
present |
2 |
|
LVEF ejection fraction |
>= 35% |
0 |
|
|
< 35% |
2 |
|
pulmonary rales (CHF) |
absent |
0 |
|
|
present |
2 |
|
COPD |
absent |
0 |
|
|
present |
2 |
where:
• In the footnote to Table 4 it mentions that the presence of congestive heart failure was used as a proxy for pulmonary rales.
• Since the score was done on patients undergoing CABG the systolic blood pressure >= 120 mm Hg AND CABG would default to SBP >= 120 mm Hg.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 33
• The higher the score the greater the risk of acute renal failure after the surgery.
|
Total Score |
Risk |
|
0 to 5 |
low (0.5%) |
|
6 to 10 |
medium (0.9%) |
|
11 to 15 |
high (2.9%) |
|
>= 16 |
very high (4%) |
Specialty: Nephrology, Clinical Laboratory
