Modifying a kidney injury score by including perioperative data Comparison of three predictive scores

Heise, Daniel; Kunze, Nils; Bürger, Julia; Quintel, Michael; Perl, Thorsten
August 2012
Central European Journal of Medicine;Aug2012, Vol. 7 Issue 4, p420
Academic Journal
At present, several scores have been developed to assess the risk of acute kidney injury (AKI) after cardiac surgery, and every score represents a compromise between the completeness of the factors and the early evaluation of the AKI risk. This study examined whether the predictive reliability of an AKI risk score can be significantly improved by applying not only preoperative risk factors but also intraoperative and postoperative parameters for the calculation of the score. Materials and methods: Three scores were deduced from the data of 662 patients undergoing cardiac surgery; these were based on preoperative (score 1), pre- and intraoperative (score 2) or on pre-, intra- and postoperative parameters (score 3). Sensitivity and specificity for the prediction of an AKI were determined from a validation population comprising 529 additional patients. Results: AKI occurred in 455 patients (38.2%). Sensitivity and specificity of the scores were 60.9% and 67.6% (score 1), 60.4% and 68.2% (score 2) and 66.8% and 64.8% (score 3). Conclusion: The inclusion of intra- and postoperative parameters into a predictive model does not significantly improve the ability to identify patients at risk of AKI. As scores based on preoperative parameters allow for the earliest possible risk stratification, they should be preferred in clinical practice.


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