Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort
Abstract
:1. Introduction
2. Material and Methods
2.1. Data Colection and Definitions
2.2. Definitions
2.3. Statistics
3. Results
3.1. Baseline Characteristics
3.2. Surgical Characteristics and Post-Intervention Lengh of Stay
3.3. AKI Characteristics
3.4. Preoperative and Intraoperative Risk Factors for CSA-AKI
3.5. Leicester Score Performance
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Euroscore II | Cleveland Clinic Score | Leicester Score |
---|---|---|
Age | --- | Age |
Gender | ||
Preoperative renal function (Cockroft–Gault formula, ml/min): >85, 50–85, <50, dialysis treatment | Preoperative renal function (creatinine, mg/dL): <1.2 mg/dL, 1.2–2.1, ≥2.1 | Renal function (Cockroft–Gault formula, ml/min): >90–60–89, 30–59, <30 |
Poor mobility | --- | --- |
Chronic lung disease | COPD requiring treatment | --- |
Previous cardiac surgery | Previous cardiac surgery | --- |
Active endocarditis | --- | --- |
Critical preoperative state | Preoperative use of IABP | --- |
Diabetes mellitus on insulin therapy | Diabetes mellitus on insulin therapy | Diabetes mellitus |
NYHA class (I–IV) | Heart failure | NYHA class (I–IV) |
Class IV angina a | --- | --- |
Left ventricular function (%): >50, 31–50, 21–30, <21 | Left ventricular function <35% | Left ventricular function (%): ≥50, 40–49, <40 |
Recent miocardial infarction (90 days) | --- | --- |
Pulmonary hypertension: ystolic arterial pressure 31–55 mmHg, >55 | --- | --- |
Urgency; (elective, urgent, emergency, salvage) | Emergency surgery | Urgency (elective, urgent, emergency) |
Type of surgery: isolated CABG, non-CABG, 2 procedures, 3 procedures | Type of surgery: CABG, valve, CABG + valve, other | Type of surgery: CABG, single valve, CABG + valve, other/multiple |
Surgery on thoracic aorta | --- | --- |
--- | --- | Body mass index (kg/m2): <20, 20–24, 25–29, 30–34, >34 |
--- | --- | Smoking habit: never, ex-smoker, current |
--- | --- | Hypertension |
--- | --- | Peripheral vascular disease |
--- | --- | Preoperative hemoglobin (g/dL) (<10, 10–11.9, ≥12) |
--- | --- | Triple vessel disease |
--- | --- | Time from catheterism to surgery |
n = 444 | n (%)/Median (IQR)/Mean+/−SD |
---|---|
Sex (%man) | 285 (64.2) |
Age (years) ≥75 years | 69 (61–76) 137 (30.9) |
History of smoking habit | 213 (49) |
Diabetes Diabetes with insulin therapy | 157 (35.36) 42 (9.45) |
Hypertension | 338 (76.1) |
BMI (kg/m2) BMI ≥ 30 | 28.33+/−4.47 136 (34.1) |
Anemia Hemoglobin (g/L) Hematocrit (%) | 87 (19.6) 134 (123–143) 39 (36–42) |
Peripheral vascular disease | 42 (9.5) |
Low ejection fraction (<40%) | 45 (10.13) |
Creatinine (mg/dL) EGFR(ml/min) EGFR<60 mL/min CKD EIII CKD EIV | 0.9 (0.73–1.06) 83.3 (65–91) 86 (19,37) 75 (87.2) 11 (12.8) |
Previous cardiac surgery | 47 (10.6) |
Procedure | Valve surgery: 199 (44.8), CABG: 171 (38.5) Valve + CABG: 74 (16.7) |
Charlson index | 4 (3–5) |
Euroscore II | 1.77 (1.08–3.02) |
Cleveland Clinic Score | 0.4 (0.4–1.8) |
Leicester Score | 18.45 (11.12–30.94) |
AKI Stages | Days between Surgery and AKI Start |
AKI stage 1: 105 (61,4%)→49 met only the “>0.3 mg/dL in 48h” criteria (46.2%) AKI stage 2: 40 (23.4%) AKI stage 3: 26 (15,2%)→15 with dialysis requirement (57.7%) | Median time from surgery to AKI (1 (1–2) First 24 h: 114 (66.7%) 48 h: 36 (22.8%) 72 h: 10 (5.85%) >72 h: 11(6.4%) |
AKI duration | Dialysis technique |
Median duration time (days): 3 (1–6) 24 h: 50 patients (29.24%) 48 h: 26 patients (15.2%) 72 h: 23patients (13.45%) >72 h: 72 patients(42.1%) | Intermittent hemodialysis: 6 patients CRRT: 5 patients Both: 4 patients * Median intermittent hemodialysis sessions: 2 (IQR 1–4) Median CRRT treatment (days): 3 (1–4) |
Total (n = 444) | No AKI (n = 273, 61.5%) | AKI (n = 171, 38.5%) | OR (IQR) | p Value | |
---|---|---|---|---|---|
PREOPERATIVE | |||||
Age ≥ 75 (years) | 137 (30.9) | 70 (25.6) | 67 (39.2) | 1.868 (1.24–2.815) | 0.003 |
Sex (%Male) | 285 (64.2) | 168 (61.5) | 117 (68.4) | 1.354 (0.904–2.029) | 0.142 |
BMI > 30 | 136 (34.1) | 76 (31.3) | 60 (35.1) | 1.373 (0.901–2.093) | 0.140 |
Ever smoked | 213 (49) | 130 (48.7) | 83 (48.5) | 1.029 (0.699–1.514) | 0.884 |
Diabetes | 157 (35.36) | 89 (32.6) | 67 (39.4) | 1.365 (0.917–2.031) | 0.125 |
Hypertension | 338 (76.1) | 194 (71.1) | 144 (84.2) | 2.172 (1.334–3.535) | 0.002 |
Peripheral vascular disease | 42 (9.5) | 13 (4.8) | 29 (16.9) | 4.085 (2.058–8.106) | <0.001 |
EF < 40% | 45 (10.13) | 22 (8.1) | 23 (13.4) | 1.773 (0.9455–3.292) | 0.070 |
Anemia | 87 (19.6) | 41 (15) | 46 (26.9) | 2.099 (1.307–3.372) | 0.002 |
Creatinine (mg/dL) | 0.9 (0.73–1.06) | 0.86 (0.7–1) | 0.99 (0.79–1.25) | 6.778 (3.405–13.49) | <0.001 |
eGFR (ml/min) | 83.3 (65–91) | 85 (71–91) | 72 (53–86) | 0.964 (0.955–0.975) | <0.001 |
EGFR < 60 mL/min | 86 (19.37) | 32 (11.7) | 54 (31.6) | 3.571 (2.190–5.822) | <0.001 |
Only CABG | 171 (38.5) | 116 (42.5) | 55 (32.2) | 0.642 (0.43–0.958) | 0.03 |
Leicester score | 18.45 (11.12–30.94) | 15.17 (9.2–22.45) | 26.81 (16.4–41.42) | 1.058 (1.042–1.073) | <0.001 |
Euroscore II | 1.77 (1.08–3.02) | 1.42 (0.95–2.61) | 2.34 (1.34–3.89) | 1.203 (1.103–1.306) | <0.001 |
Cleveland Clinic Score | 0.4 (0.4–1.8) | 0.4 (0.4–1.8) | 1.8 (0,4–1.8) | 1.188 (1.081–1.306) | <0.001 |
Charlson Index | 4 (3–5) | 3 (2–5) | 4 (3–6) | 1.373 (1.226–1.537) | <0.001 |
INTRAOPERATIVE | |||||
Blood transfusion | 115 (26) | 61 (22.4) | 54 (31.6) | 1.610 (1.047–2.477) | 0.030 |
Vasodilator agents | 153 (34.5) | 107 (39.2) | 46 (26.9) | 0.576 (0.379–0.873) | 0.009 |
Dobutamine | 198 (45.2) | 118 (43.2) | 78 (45.6) | 1.114 (0.758–1.637) | 0.584 |
Furosemide use | 114 (25.7) | 62 (22.7) | 52 (30.4) | 1.5 (0.974–2.310) | 0.066 |
Vasoconstrictor agents | 298 (67.12) | 150 (54.9) | 148 (86.5) | 1.543 (1.039–2.292) | 0.032 |
CPB time (min) | 91.5 (72–117) | 88 (71–110) | 100 (74–127) | 1.007 (1.002–1.012) | 0.005 |
CPB time > 90 min | 226 (51.4) | 124 (45.8) | 102 (59.6) | 1.805 (1.222–2.666) | 0.003 |
Ischemia time | 65 (50–80.25) | 60 (48–80) | 75 (54–92) | 1.012 (1.005–1.018) | <0.001 |
Ischemia time > 70 min | 179 (41.2) | 91 (33.8) | 88 (51.5) | 2.235 (1.504–3.324) | <0.001 |
Variable | OR (CI) | p-Value |
---|---|---|
Age ≥ 75 years | 1.483 (0.928–2.371) | 0.099 |
Hypertension | 1.883 (1.086–3.265) | 0.024 |
EGFR < 60mL/min | 2.365 (1.375–4.070) | 0.002 |
Anemia | 1.642 (0.918–2.939) | 0.095 |
Bypass | 0.838 (0,503–1.397) | 0.499 |
Peripheral vascular disease | 4.66 (2.134–10.177) | <0.001 |
Blood transfusion | 0.87 (0.509–1.487) | 0.608 |
Vasopressors agents | 1.261 (0.784–2.027) | 0.34 |
Vasodilators agents | 0.694 (0.412–1.168) | 0.169 |
CPB time >90 min | 1.019 (0.553–1.879) | 0.951 |
Isquemia time >70 min | 1.844 (0.979–3.473) | 0.058 |
Discrimination | Calibration | ||
---|---|---|---|
AUC (95% CI) | p Value | Chi Square p Value a | |
Leicester score | 0.721 (0.671–0.771) | <0.001 | 10.1 0.225 |
Cleveland Clinic Score | 0.595 (0.54–0.65) | 0.001 | 2.631 0.105 |
Euroscore | 0.662 (0.611–0.713) | <0.001 | 11.48 0.176 |
CCS-Euroscore II | CCS-LS | Euroscore II-LS | |
---|---|---|---|
Difference between areas | 0.067 | 0.126 | 0.059 |
Stadard Error (CI) | 0.025 (0.017–0.112) | 0.030 (0.067–0.185) | 0.027 (0.006–0.112) |
Z statistic | 2.633 | 4.203 | 2.199 |
p-Value | 0.009 | <0.001 | 0.028 |
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Molina Andújar, A.; Lucas, A.; Escudero, V.J.; Rovira, I.; Matute, P.; Ibañez, C.; Blasco, M.; Sandoval, E.; Ruiz, J.; Chorda Sánchez, M.; et al. Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort. J. Clin. Med. 2022, 11, 904. https://doi.org/10.3390/jcm11040904
Molina Andújar A, Lucas A, Escudero VJ, Rovira I, Matute P, Ibañez C, Blasco M, Sandoval E, Ruiz J, Chorda Sánchez M, et al. Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort. Journal of Clinical Medicine. 2022; 11(4):904. https://doi.org/10.3390/jcm11040904
Chicago/Turabian StyleMolina Andújar, Alícia, Alvaro Lucas, Victor Joaquin Escudero, Irene Rovira, Purificación Matute, Cristina Ibañez, Miquel Blasco, Elena Sandoval, Jesús Ruiz, Marina Chorda Sánchez, and et al. 2022. "Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort" Journal of Clinical Medicine 11, no. 4: 904. https://doi.org/10.3390/jcm11040904
APA StyleMolina Andújar, A., Lucas, A., Escudero, V. J., Rovira, I., Matute, P., Ibañez, C., Blasco, M., Sandoval, E., Ruiz, J., Chorda Sánchez, M., Piñeiro, G. J., Quintana, E., & Poch, E. (2022). Risk Factors for Acute Kidney Injury Following Cardiac Surgery and Performance of Leicester Score in a Spanish Cohort. Journal of Clinical Medicine, 11(4), 904. https://doi.org/10.3390/jcm11040904