背景:没有可靠的临床工具来预测急性肾损伤(AKI)进展。我们旨在探索一种评分系统,用于预测心脏手术后早期AKI患者在7天内进展为严重AKI或死亡的复合结局。
方法:在本研究中,我们使用了两个独立的队列,纳入心脏手术后48h内出现轻度/中度AKI的患者.最终,来自MIMIC-IV数据库的3188名患者被用作衍生队列,而来自中山队列的499例患者被用作外部验证。主要结局由纳入后7天内进展为严重AKI或死亡的复合结局定义。通过LASSO回归分析确定的变量被输入逻辑回归模型并用于构建风险评分。
结果:复合结局占推导和验证队列的3.7%(n=119)和7.6%(n=38),分别。将六个预测因子汇总为风险评分(AKI-Pro评分),包括女性,基线eGFR,主动脉手术,改良呋塞米反应性指数(mFRI),SOFA,AKI阶段。我们将风险评分分为四组:低,中度,高,和非常高的风险。在推导和验证队列中,风险评分显示出令人满意的预测性辨别和校准。AKI-Pro评分比CRATE评分更能区分复合结局,克利夫兰得分,AKICS得分,简化肾指数,和SRI风险评分(均P<0.05)。
结论:AKI-Pro评分是一种新的临床工具,可以帮助临床医生识别AKI进展或死亡高风险的早期AKI患者。
BACKGROUND: No reliable clinical tools exist to predict acute kidney injury (AKI) progression. We aim to explore a scoring system for predicting the composite outcome of progression to severe AKI or death within seven days among early AKI patients after cardiac surgery.
METHODS: In this study, we used two independent cohorts, and patients who experienced mild/moderate AKI within 48 h after cardiac surgery were enrolled. Eventually, 3188 patients from the MIMIC-IV database were used as the derivation cohort, while 499 patients from the Zhongshan cohort were used as external validation. The primary outcome was defined by the composite outcome of progression to severe AKI or death within seven days after enrollment. The variables identified by LASSO regression analysis were entered into logistic regression models and were used to construct the risk score.
RESULTS: The composite outcome accounted for 3.7% (n = 119) and 7.6% (n = 38) of the derivation and validation cohorts, respectively. Six predictors were assembled into a risk score (AKI-Pro score), including female, baseline eGFR, aortic surgery, modified furosemide responsiveness index (mFRI), SOFA, and AKI stage. And we stratified the risk score into four groups: low, moderate, high, and very high risk. The risk score displayed satisfied predictive discrimination and calibration in the derivation and validation cohort. The AKI-Pro score discriminated the composite outcome better than CRATE score, Cleveland score, AKICS score, Simplified renal index, and SRI risk score (all P < 0.05).
CONCLUSIONS: The AKI-Pro score is a new clinical tool that could assist clinicians to identify early AKI patients at high risk for AKI progression or death.