Application of Acute Kidney Injury Criteria and Classification to Predict Mortality Following Cardiovascular Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xudong , CHE Miaolin , XIE Bo , LIAN Feng , LIU Sha , HU Zhenlei , XUE Song.

1. Department of　Cardiovascular and Thoracic Surgery， Renji Hospital， School of Medicine， Shanghai Jiaotong University， Shanghai 200025， P. R. China;;
2. Department of Nephrology， Renji Hospital， School of Medicine， Shanghai Jiaotong University， Shanghai 200025， P. R. China;

Corresponding author：

Keywords：

Cardiovascular surgery; 　Acute kidney injury; 　Mortality; 　Prediction

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Abstract：　Objective　To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in　patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality.　Methods　A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative，　and postoperative risk factors related to AKI.　Results　Among the 1 056 patients， 328 patients（31.06%） had AKI.　In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）.　Conclusion　Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.

Citation： WANG Xudong,CHE Miaolin,XIE Bo,LIAN Feng,LIU Sha,HU Zhenlei,XUE Song.. Application of Acute Kidney Injury Criteria and Classification to Predict Mortality Following Cardiovascular Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 619-623. doi: Copy

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2.	Che M， Li Y， Liang X， et al. Prevalence of acute kidney injury following cardiac surgery and related risk factors in Chinese patients. Nephron Clin Pract， 2011， 117 （4）：c305-c311.
3.	王旭冬，车妙琳，谢波，等. 美国克利夫兰大学急性肾衰竭风险评分系统在我国成人心脏手术患者中的应用. 中国胸心血管外科临床杂志， 2012， 19 （3）：262-265.
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6.	急性肾损伤专家共识小组. 急性肾损伤诊断与分类专家共识. 中华肾脏病杂志， 2006， 22 （11）：661-663.
7.	Bellomo R， Ronco C， Kellum JA， et al. Acute renal failure - definition， outcome measures， animal models， fluid therapy and information technology needs：the Second International Consensus Conference of the Acute Dialysis Quality Initiative （ADQI） Group. Crit Care， 2004， 8 （4）：R204-R212.
8.	Palomba H， de CastroⅠ， Neto AL， et al. Acute kidney injury　prediction following elective cardiac surgery：AKICS Score. Kidney Int， 2007， 72 （5）：624-631.
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.	Rosner MH， Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol， 2006， 1 （1）：19-32.
11.	Bellomo R， Auriemma S， Fabbri A， et al. The pathophysiology of cardiac surgery-associated acute kidney injury （CSA-AKI）. Int J Artif Organs， 2008， 31 （2）：166-178.
12.	Lassnigg A， Schmid ER， Hiesmayr M， et al. Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery：do we have to revise current definitions of acute renal failure ? Crit Care Med， 2008， 36 （4）：1129-1137.
13.	Tidman M， Sjöström P， Jones I. A comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant， 2008， 23 （1）：154-160.
14.	Coca SG， Peixoto AJ， Garg AX， et al. The prognostic importance of a small acute decrement in kidney function in hospitalized patients：a systematic review and meta-analysis. Am J Kidney Dis， 2007， 50 （5）：712-720.
15.	Chertow GM， Burdick E， Honour M， et al. Acute kidney injury， mortality， length of stay， and costs in hospitalized patients. J Am Soc Nephrol， 2005， 16 （11）：3365-3370.
16.	Dasta JF， Kane-Gill SL， Durtschi AJ， et al. Costs and outcomes of acute kidney injury （AKI） following cardiac surgery. Nephrol Dial Transplant， 2008， 23 （6）：1970-1974.
17.	Boyle JM， Moualla S， Arrigain S， et al. Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation. Am J Kidney Dis， 2006， 48 （5）：787-796.
18.	Overberger P， Pesacreta M， Palevsky PM， et al. Management of renal replacement therapy in acute kidney injury：a survey of practitioner prescribing practices. Clin J Am Soc Nephrol， 2007， 2 （4）：623-630.
19.	Ronco C， Bellomo R. Dialysis in intensive care unit patients with acute kidney injury：continuous therapy is superior. Clin J Am Soc Nephrol， 2007， 2 （3）：597-600.
20.	Bent P， Tan HK， Bellomo R， et al. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg， 2001， 71 （3）：832-837.
21.	VA/NIH Acute Renal Failure Trial Network， Palevsky PM， Zhang JH， et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med， 2008， 359 （1）：7-20.
22.	Hoste EA， Clermont G， Kersten A， et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients：a cohort analysis. Crit Care， 2006， 10 （3）：R73.
23.	Kuitunen A， Vento A， Suojaranta-Ylinen R， et al. Acute renal failure after cardiac surgery：evaluation of the RIFLE classification. Ann Thorac Surg， 2006， 81 （2）：542-546.
24.	闫晓蕾，侯晓彤，杨勇，等. 肾功能损伤分级在心脏术后肾脏替代治疗中的应用. 中国胸心血管外科临床杂志， 2010， 17 （2）：165-167.

1. 　Rosner MH， Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol， 2006， 1 （1）：19-32.
2. 　Che M， Li Y， Liang X， et al. Prevalence of acute kidney injury following cardiac surgery and related risk factors in Chinese patients. Nephron Clin Pract， 2011， 117 （4）：c305-c311.
3. 　王旭冬，车妙琳，谢波，等. 美国克利夫兰大学急性肾衰竭风险评分系统在我国成人心脏手术患者中的应用. 中国胸心血管外科临床杂志， 2012， 19 （3）：262-265.
4. 　Mammen C， Al Abbas A， Skippen P， et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit：a prospective cohort study. Am J Kidney Dis， 2012， 59 （4）：523-530.
5. 　Mehta RL， Kellum JA， Shah SV， et al. Acute Kidney Injury Network：report of an initiative to improve outcomes in acute kidney injury. Crit Care， 2007， 11 （2）：R31.
6. 　急性肾损伤专家共识小组. 急性肾损伤诊断与分类专家共识. 中华肾脏病杂志， 2006， 22 （11）：661-663.
7. 　Bellomo R， Ronco C， Kellum JA， et al. Acute renal failure - definition， outcome measures， animal models， fluid therapy and information technology needs：the Second International Consensus Conference of the Acute Dialysis Quality Initiative （ADQI） Group. Crit Care， 2004， 8 （4）：R204-R212.
8. 　Palomba H， de CastroⅠ， Neto AL， et al. Acute kidney injury　prediction following elective cardiac surgery：AKICS Score. Kidney Int， 2007， 72 （5）：624-631.
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. 　Rosner MH， Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol， 2006， 1 （1）：19-32.
11. 　Bellomo R， Auriemma S， Fabbri A， et al. The pathophysiology of cardiac surgery-associated acute kidney injury （CSA-AKI）. Int J Artif Organs， 2008， 31 （2）：166-178.
12. 　Lassnigg A， Schmid ER， Hiesmayr M， et al. Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery：do we have to revise current definitions of acute renal failure ? Crit Care Med， 2008， 36 （4）：1129-1137.
13. 　Tidman M， Sjöström P， Jones I. A comparison of GFR estimating formulae based upon s-cystatin C and s-creatinine and a combination of the two. Nephrol Dial Transplant， 2008， 23 （1）：154-160.
14. 　Coca SG， Peixoto AJ， Garg AX， et al. The prognostic importance of a small acute decrement in kidney function in hospitalized patients：a systematic review and meta-analysis. Am J Kidney Dis， 2007， 50 （5）：712-720.
15. 　Chertow GM， Burdick E， Honour M， et al. Acute kidney injury， mortality， length of stay， and costs in hospitalized patients. J Am Soc Nephrol， 2005， 16 （11）：3365-3370.
16. 　Dasta JF， Kane-Gill SL， Durtschi AJ， et al. Costs and outcomes of acute kidney injury （AKI） following cardiac surgery. Nephrol Dial Transplant， 2008， 23 （6）：1970-1974.
17. 　Boyle JM， Moualla S， Arrigain S， et al. Risks and outcomes of acute kidney injury requiring dialysis after cardiac transplantation. Am J Kidney Dis， 2006， 48 （5）：787-796.
18. 　Overberger P， Pesacreta M， Palevsky PM， et al. Management of renal replacement therapy in acute kidney injury：a survey of practitioner prescribing practices. Clin J Am Soc Nephrol， 2007， 2 （4）：623-630.
19. 　Ronco C， Bellomo R. Dialysis in intensive care unit patients with acute kidney injury：continuous therapy is superior. Clin J Am Soc Nephrol， 2007， 2 （3）：597-600.
20. 　Bent P， Tan HK， Bellomo R， et al. Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg， 2001， 71 （3）：832-837.
21. 　VA/NIH Acute Renal Failure Trial Network， Palevsky PM， Zhang JH， et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med， 2008， 359 （1）：7-20.
22. 　Hoste EA， Clermont G， Kersten A， et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients：a cohort analysis. Crit Care， 2006， 10 （3）：R73.
23. 　Kuitunen A， Vento A， Suojaranta-Ylinen R， et al. Acute renal failure after cardiac surgery：evaluation of the RIFLE classification. Ann Thorac Surg， 2006， 81 （2）：542-546.
24. 　闫晓蕾，侯晓彤，杨勇，等. 肾功能损伤分级在心脏术后肾脏替代治疗中的应用. 中国胸心血管外科临床杂志， 2010， 17 （2）：165-167.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of Acute Kidney Injury Criteria and Classification to Predict Mortality Following Cardiovascular Surgery

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