Prediction of acute kidney injury within 30 days of cardiac surgery

Ng, S.Y.; Sanagou, Masoumeh; Wolfe, Rory; Cochrane, Andrew; Smith, Julian Anderson; Reid, Christopher M.

doi:10.1016/j.jtcvs.2013.06.049

Cited by 71 publications

(82 citation statements)

References 25 publications

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“…We excluded 268 studies: animal studies (15), reviews (42), no epidemiological data available (177), not about CRS-1 (23), no data about AKI or WRF (8) and studies evaluating a specific intervention (3). Finally, we included 64 papers (n = 509,766 patients), containing data on AKI in AHF patients (18 studies; 29,202 patients) [4,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26], ACS (15 studies; 282,113 patients) [13,27,28,29,30,31,32,33,34,35,36,37,38,39,40] and CS (32 studies; 198,451 patients) [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72] (table 1). One study contained information about AHF as well as ACS and is therefore used in both groups [13].…”

Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

et al. 2015

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Background: We evaluated the epidemiology and outcome of acute kidney injury (AKI) in patients with cardiorenal syndrome type 1 (CRS-1) and its subgroups: acute heart failure (AHF), acute coronary syndrome (ACS) and after cardiac surgery (CS). Summary: We performed a systematic review and meta-analysis. CRS-1 was defined by AKI (based on RIFLE, AKIN and KDIGO), worsening renal failure (WRF) and renal replacement therapy (RRT). We investigated the three most common clinical causes of CRS-1: AHF, ACS and CS. Out of 332 potential papers, 64 were eligible - with AKI used in 41 studies, WRF in 25 and RRT in 20. The occurrence rate of CRS-1, defined by AKI, WRF and RRT, was 25.4, 22.4 and 2.6%, respectively. AHF patients had a higher occurrence rate of CRS-1 compared to ACS and CS patients (AKI: 47.4 vs. 14.9 vs. 22.1%), but RRT was evenly distributed among the types of acute cardiac disease. AKI was associated with an increased mortality rate (risk ratio = 5.14, 95% CI 3.81-6.94; 24 studies and 35,227 patients), a longer length of stay in the intensive care unit [LOS_ICU] (median duration = 1.37 days, 95% CI 0.41-2.33; 9 studies and 10,758 patients) and a longer LOS in hospital [LOS_hosp] (median duration = 3.94 days, 95% CI 1.74-6.15; 8 studies and 35,227 patients). Increasing AKI severity was associated with worse outcomes. The impact of CRS-1 defined by AKI on mortality was greatest in CS patients. RRT had an even greater impact compared to AKI (mortality risk ratio = 9.2, median duration of LOS_ICU = 10.6 days and that of LOS_hosp = 20.2 days). Key Messages: Of all included patients, almost one quarter developed AKI and approximately 3% needed RRT. AHF patients experienced the highest occurrence rate of AKI, but the impact on mortality was greatest in CS patients.

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Section: Resultsmentioning

confidence: 99%

Acute Kidney Injury in Cardiorenal Syndrome Type 1 Patients: A Systematic Review and Meta-Analysis

Vandenberghe¹,

et al. 2015

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“…The ROC-AUC varied between 0.77 and 0.84 in both internal and validation cohorts and most of the studies reported an array of common predictors using mainly logistic regression analysis as a computational tool. Two more recent studies in the United Kingdom and Australia used larger data registries for development and validation of predictive scores that included several intraoperative variables, although model performance remained less than 0.82 73,74 . For patients undergoing non-cardiac surgery few preoperative predictive models were developed, using either only severe AKI as an end-point or limiting inclusion to a specific type of surgery 22,75 .…”

Section: Clinical Risk Scoresmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Hobson

Ruchi

2017

Critical Care Clinics

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Synopsis Acute kidney injury (AKI) is a common complication in the surgical patient and is associated with increases in mortality, an increased risk for chronic kidney disease (CKD) and hemodialysis after discharge, and increased cost. Better understanding of the risk factors that contribute to perioperative AKI has led to improved AKI prediction and will eventually lead to improved prevention of AKI, mitigation of injury when AKI occurs and enhanced recovery in patients who sustain AKI. The development of advanced clinical prediction scores for AKI, new imaging techniques and novel biomarkers for early detection of AKI provides new tools toward these ends.

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“…Transcatheter aortic valve replacement (TAVR) is an emerging alternative to surgery for patients with severe aortic stenosis perceived to be at increased risk for perioperative mortality . TAVR patients are universally elderly and often possess numerous comorbid conditions, many of which are known risk factors for acute kidney injury (AKI) after cardiac procedures . The incidence of AKI after TAVR is consequently high, with AKI occurring in 8% to 42% of cases .…”

Section: Introductionmentioning

confidence: 99%