A Prediction Model for Acute Kidney Injury After Pericardiectomy: An Observational Study

Abstract

ObjectivesAcute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We aimed to investigate potential risk factors and consequences and establish a prediction model.MethodsWe selected patients with constrictive pericarditis receiving isolated pericardiectomy from January 2013 to January 2021. Patients receiving concomittant surgery or repeat percardiectomy, as well as end-stage of renal disease were excluded. Acute kidney injury was diagnosed and classified according to the KDIGO criteria. Clinical features were compared between patients with and without postoperative acute kidney injury. A prediction model was established based on multivariable regression analysis.ResultsAmong two hundred and eleven patients, ninety-five (45.0%) developed postoperative acute kidney injury, with fourty-three (45.3%), twenty-eight (29.5%), and twenty-four (25.3%) in mild, moderate and severe stages, respectively. Twenty-nine (13.7%) patients received hemofiltration. Nine (4.3%) patients died perioperatively and were all in the acute kidney injury (9.5%) group. Eleven (5.2%) patients were considered to have chronic renal dysfunction states at the 6-month postoperative follow-up, and eight (72.7%) of them experienced moderate to severe stages of postoperative acute kidney injury. Univariable analysis showed that patients with acute kidney injury were older (difference 8 years, P < 0.001); had higher body mass index (difference 1.68 kg·m−2, P = 0.002); rates of smoking (OR = 2, P = 0.020), hypertension (OR = 2.83, P = 0.004), and renal dysfunction (OR = 3.58, P = 0.002); higher central venous pressure (difference 3 cm H2O, P < 0.001); and lower cardiac index (difference −0.23 L·min−1·m−2, P < 0.001) than patients without acute kidney injury. Multivariable regression analysis showed that advanced age (OR 1.03, P = 0.003), high body mass index (OR 1.10, P = 0.024), preoperative atrial arrhythmia (OR 3.12, P = 0.041), renal dysfunction (OR 2.70 P = 0.043), high central venous pressure (OR 1.12, P = 0.002), and low cardiac index (OR 0.36, P = 0.009) were associated with a high risk of postoperative acute kidney injury. A nomogram was established based on the regression results. The model showed good model fitness (Hosmer-Lemeshow test P = 0.881), with an area under the curve value of 0.78 (95% CI: 0.71, 0.84, P < 0.001).ConclusionThe prediction model may help with early recognition, management, and reduction of acute kidney injury after pericardiectomy.

Construction and Validation of a Nomogram for Predicting Acute Kidney Injury After Hip Fracture Surgery

“…Several other studies reported that preexisting CKD was a risk factor for AKI after surgery. [20][21][22] Fontecha-Barriuso et al 23 reviewed the relationship of pre-existing CKD with post-surgical AKI and found that these patients had increased risk of AKI. CKD is characterized by progressive and irreversible loss of kidney function.…”

“…Other studies used nomogram models to assess the risk of AKI after surgery, and these models had good performance, but they did not focus on patients receiving hip fracture surgery. 20,21 In particular, Yu et al examined patients undergoing liver resection 20 and Wang et al examined patients undergoing pericardiectomy. 21 Our nomogram model incorporated preoperative and perioperative factors in patients undergoing hip fracture surgery and showed good performance in the internal and external validation.…”

“…20,21 In particular, Yu et al examined patients undergoing liver resection 20 and Wang et al examined patients undergoing pericardiectomy. 21 Our nomogram model incorporated preoperative and perioperative factors in patients undergoing hip fracture surgery and showed good performance in the internal and external validation. The nomogram is convenient and easy to use in clinical practice for its clear diagram and algorithm.…”

Postoperative acute kidney injury after on-pump cardiac surgery in patients with connective tissue disease

“…Wang's team from West China Hospital even established a predictive model incorporating 10 predictors; this model could be used not only for predicting AKI after on-pump cardiac surgery but also for predicting the severity of AKI, and external validation was successful (1). Wang and colleagues from Peking Union Medical College Hospital established a model for predicting AKI after pericardiectomy (22). However, due to the rarity of comorbid CTD, risk factors for postoperative AKI occurrence in patients with CTD undergoing on-pump cardiac surgery were not available in the literature.…”

Pericardiectomy for Constrictive Pericarditis with or without Cardiopulmonary Bypass

“…Therefore, preventing the development of acute renal injury after cardiac surgery, optimizing pre-, intra-and post-operative factors, to reduce acute renal injury, contribute to better postoperative results, and reduce the rate of acute renal injury, morbidity, and mortality. 45,46 Strengths and limitations of pericardiectomy with or without cardiopulmonary bypass were showed in Table 1.…”