Park et al reported the Simple Postoperative AKI Risk (SPARK) score for evaluating a patient having noncardiac surgery. This can help to identify a patient at risk for acute kidney injury (AKI) after surgery. The authors are from multiple institutions in South Korea.
Patient selection: noncardiac surgery, eGFR >= 15 mL per min per 1.73 square meters
Parameters:
(1) age in years
(2) eGFR in mL per min per 1.73 square meters
(3) urine dipstick albumin
(4) sex
(5) expected surgical duration in hours
(6) emergency operation
(7) diabetes mellitus
(8) RAAS blockade (renal-angiotensin-aldosterone system)
(9) serum albumin in g/dL
(10) hemoglobin in g/dL and sex
(11) serum sodium in mmol/L
|
Parameter
|
Finding
|
Points
|
|
age in years
|
< 40 years
|
0
|
|
|
40 to 59.9 years
|
6
|
|
|
60 to 79.9 years
|
9
|
|
|
>= 80 years
|
13
|
|
eGFR
|
>= 60
|
0
|
|
|
45 to 59.9
|
8
|
|
|
30 to 44.9
|
15
|
|
|
15 to 29.9
|
22
|
|
albumin urine dipstick
|
negative or trace
|
0
|
|
|
>= 1+
|
6
|
|
sex
|
female
|
0
|
|
|
male
|
8
|
|
expected duration
|
|
5 * (hours)
|
|
emergency surgery
|
no
|
0
|
|
|
yes
|
7
|
|
diabetes mellitus
|
no
|
0
|
|
|
yes
|
4
|
|
RAAS blockade
|
no
|
0
|
|
|
yes
|
6
|
|
serum albumin
|
>= 3.5 g/dL
|
0
|
|
|
< 3.5 g/dL
|
8
|
|
hemoglobin
|
male and >= 13 g/dL
|
0
|
|
|
male and < 13 g/dL
|
4
|
|
|
female and >= 12 g/dL
|
0
|
|
|
female and < 12 g/dL
|
4
|
|
serum sodium
|
>= 135 mmol/L
|
0
|
|
|
< 135 mmol/L
|
3
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: over 110 (depends on surgery duration)
|
Score
|
Class
|
Any AKI
|
Critical AKI
|
|
< 20
|
A
|
< 2%
|
< 2%
|
|
20 to 39.9
|
B
|
2 to 10%
|
< 2%
|
|
40 to 59.9
|
C
|
10 to 20%
|
2 to 10%
|
|
>= 60
|
D
|
>= 20%
|
>= 10%
|
Performance:
• The area under the ROC curve was 0.8 for derivation and 0.72 for validation cohorts.
