Validation of Four Prediction Scores for Cardiac Surgery-Associated Acute Kidney Injury in Chinese Patients

Abstract Objective: To assess the clinical value of four models for the prediction of cardiac surgery-associated acute kidney injury (CSA-AKI) and severe AKI which renal replacement therapy was needed (RRT-AKI) in Chinese patients. Methods: 1587 patients who underwent cardiac surgery in the department of cardiac surgery in the Zhongshan Hospital, Fudan University, between January 2013 and December 2013 were enrolled in this research. Evaluating the predicting value for cardiac surgery-associated AKI (AKICS score) and RRT-AKI (Cleveland score, SRI and Mehta score) by Hosmer-Lemeshow goodness-of-fit test for the calibration and area under receiver operating characteristic curve (AUROC) for the discrimination. Results: Based on 2012 KDIGO (Kidney Disease: Improving Global Outcomes) AKI definition, the incidence of AKI and RRT-AKI was 37.4% (594/1587) and 1.1% (18/1587), respectively. The mortality of AKI and RRT-AKI was 6.1% (36/594) and 66.7% (12/18), respectively, while the total mortality was 2.8% (44/1587). The discrimination (AUROC=0.610) for the prediction of CSA-AKI of AKICS was low, while the calibration (x2=7.55, P=0.109) was fair. For the prediction of RRT-AKI, the discrimination of Cleveland score (AUROC=0.684), Mehta score (AUROC=0.708) and SRI (AUROC=0.622) were not good; while the calibration of them were fair (Cleveland score x2=1.918, P=0.166; Mehta score x2=9.209, P=0.238; SRI x2=2.976, P=0.271). Conclusion: In our single-center study, based upon valve surgery dominant and less diabetes mellitus patients, according to KDIGO AKI definition, the predictive value of the four models, combining discrimination and calibration, for respective primary event, were not convincible.摘要 目的：评估四种模型在中国患者中预测心脏手术相关急性肾损伤（cardiac surgery-associated acute kidney injury, CSA-AKI）及需肾脏替代治疗的重症急性肾损伤（renal replacement therapy-requiring severe AKI, RRT-AKI）的临床价值。 方法：本研究纳入2013年1月至2013年12月于复旦大学附属中山医院心脏外科行心脏手术的1587例患者。采用Hosmer-Lemeshow拟合优度检验评价模型校准度，以受试者工作特征曲线下面积（area under receiver operating characteristic curve, AUROC）评价模型区分度，分别评估AKICS评分对心脏手术相关AKI的预测价值，以及克利夫兰评分（Cleveland score）、SRI、Mehta评分对需肾脏替代治疗的AKI的预测价值。 结果：基于2012年改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes, KDIGO）制定的急性肾损伤定义，本研究队列中AKI与RRT-AKI的发生率分别为37.4%（594/1587）与1.1%（18/1587）。AKI患者与RRT-AKI患者的病死率分别为6.1%（36/594）与66.7%（12/18），总体病死率为2.8%（44/1587）。AKICS评分预测CSA-AKI的区分度欠佳（AUROC=0.610），但其校准度尚可（χ²=7.55，P=0.109）。针对RRT-AKI的预测，克利夫兰评分（AUROC=0.684）、Mehta评分（AUROC=0.708）及SRI（AUROC=0.622）的区分度均不佳，但三者的校准度均尚可（克利夫兰评分：χ²=1.918，P=0.166；Mehta评分：χ²=9.209，P=0.238；SRI：χ²=2.976，P=0.271）。 结论：本单中心研究的队列以瓣膜手术为主且糖尿病患者占比较低，基于KDIGO急性肾损伤定义，综合区分度与校准度两方面来看，四种模型对各自对应结局事件的预测价值均未达到令人信服的水平。