Validation of Cleveland Clinical Score Predicting Acute Renal Failure after Cardiac Surgery in Chinese Adult Department of_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xudong , CHE Miaolin , XIE Bo

Cardiothoracic Surgery and Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200025, P. R. China;

Corresponding author：

Keywords：

Cleveland Clinical Score; Cardiac surgery; Acute renal failure; Predicting

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Abstract： Objective To validate the value of Cleveland Clinical Score to predict acute renal failure（ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females，were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity：0 to 2 point（n=979）, 3 to 5 point （n=1 116）, 6 to 8 point（n=54）, 9 to 13 point（n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0.92%, 1.88%, 12.96%, and 25.00%, respectively； MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0.92%, 4.21%, 25.93%, and 50.00%, respectively. There was significant dif ference among the four categories in ARF rate （χ2=55.635, P=0.000），MOSF rate（χ2=16.080, P=0.001）, and mortality （χ2=71.470, P=0.000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0.775 （95%CI 0.713 to 0.837, P=0.000）and 0.764（95%CI, 0.711 to 0.817, P=0.000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for patients at high risk of postoperative ARF.

Citation： WANG Xudong ,CHE Miaolin,XIE Bo,et al.. Validation of Cleveland Clinical Score Predicting Acute Renal Failure after Cardiac Surgery in Chinese Adult Department of. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 262-265. doi: Copy

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3.	Candela-Toha A, Elías-Martín E, Abraira V, et al. Predicting acute renal failure after cardiac surgery：external validation of two new clinical scores. Clin J Am Soc Nephrol, 2008, 3（5）：1260-1265.
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5.	Englberger L, Suri RM, Li Z, et al. Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis, 2010, 56（4）：623-631.
6.	章淬, 王翔, 赵谊, 等. 美国克利夫兰大学急性肾功能衰竭评分系统在中国人心脏手术围术期的应用. 中国胸心血管外科临床杂志, 2010, 17（6）：456-469.
7.	Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. Clin J Am Soc Nephrol, 2008, 3（2）：546-553.
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9.	Mehta RH, Grab JD, O’Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation, 2006, 114（21）：2208-2216.
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11.	Ricci Z, Bellomo R, Ronco C. Dose of dialysis in acute renal failure. Clin J Am Soc Nephrol, 2006, 1（3）：380-388.
12.	Liu KD, Himmelfarb J, Paganini E, et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol, 2006, 1（5）：915-919.
13.	Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin （NGAL） as a biomarker for acute renal injury after cardiac surgery. Lancet, 2005, 365（9466）：1231-1238.
14.	Siew ED, Ikizler TA, Gebretsadik T, et al. Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol, 2010, 5（8）：1497-1505.
15.	Koyner JL, Vaidya VS, Bennett MR, et al. Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury. Clin J Am Soc Nephrol, 2010, 5（12）：2154-2165.
16.	Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin （NGAL） in diagnosis and prognosis in acute kidney injury：a systematic review and meta-analysis. Am J Kidney Dis, 2009, 54（6）：1012-1024.

1. 　Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol, 2006, 1（1）：19-32.
2. 　Thakar CV, Arrigain S, Worley S, et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol, 2005, 16（1）：162-168.
3. 　Candela-Toha A, Elías-Martín E, Abraira V, et al. Predicting acute renal failure after cardiac surgery：external validation of two new clinical scores. Clin J Am Soc Nephrol, 2008, 3（5）：1260-1265.
4. 　Di Bella I, Da Col U, Ciampichini R, et al. Validation of a new scoring system to predict the risk of postoperative acute renal failure in cardiac surgery. G Ital Cardiol, 2007, 8（5）：306-310.
5. 　Englberger L, Suri RM, Li Z, et al. Validation of clinical scores predicting severe acute kidney injury after cardiac surgery. Am J Kidney Dis, 2010, 56（4）：623-631.
6. 　章淬, 王翔, 赵谊, 等. 美国克利夫兰大学急性肾功能衰竭评分系统在中国人心脏手术围术期的应用. 中国胸心血管外科临床杂志, 2010, 17（6）：456-469.
7. 　Herget-Rosenthal S, Saner F, Chawla LS. Approach to hemodynamic shock and vasopressors. Clin J Am Soc Nephrol, 2008, 3（2）：546-553.
8. 　Abuelo JG. Normatensive ischemic acute renal failure. N Engl J Med, 2007, 357（8）：797-805.
9. 　Mehta RH, Grab JD, O’Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation, 2006, 114（21）：2208-2216.
10. 　Wijeysundera DN, Karkouti K, Dupuis JY, et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery. JAMA, 2007, 297（16）：1801-1809.
11. 　Ricci Z, Bellomo R, Ronco C. Dose of dialysis in acute renal failure. Clin J Am Soc Nephrol, 2006, 1（3）：380-388.
12. 　Liu KD, Himmelfarb J, Paganini E, et al. Timing of initiation of dialysis in critically ill patients with acute kidney injury. Clin J Am Soc Nephrol, 2006, 1（5）：915-919.
13. 　Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin （NGAL） as a biomarker for acute renal injury after cardiac surgery. Lancet, 2005, 365（9466）：1231-1238.
14. 　Siew ED, Ikizler TA, Gebretsadik T, et al. Elevated urinary IL-18 levels at the time of ICU admission predict adverse clinical outcomes. Clin J Am Soc Nephrol, 2010, 5（8）：1497-1505.
15. 　Koyner JL, Vaidya VS, Bennett MR, et al. Urinary biomarkers in the clinical prognosis and early detection of acute kidney injury. Clin J Am Soc Nephrol, 2010, 5（12）：2154-2165.
16. 　Haase M, Bellomo R, Devarajan P, et al. Accuracy of neutrophil gelatinase-associated lipocalin （NGAL） in diagnosis and prognosis in acute kidney injury：a systematic review and meta-analysis. Am J Kidney Dis, 2009, 54（6）：1012-1024.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Validation of Cleveland Clinical Score Predicting Acute Renal Failure after Cardiac Surgery in Chinese Adult Department of

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