Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

Yang LI; Xue-Jian HOU; Tao-Shuai LIU; Shi-Jun XU; Zhu-Hui HUANG; Peng-Yun YAN; Xiao-Yu XU; Ran DONG

摘要：BACKGROUND Acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with significant mor-bidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and div-ided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO) criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic (ROC) curve.RESULTS The incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) was 24.17％,and 0.53％ of AKI patients re-quired dialysis (AKI-D).Among the derivation cohort,multivariable logistic regression showed that age ≥ 70 years,body mass in-dex (BMI) ≥ 25 kg/m2,estimated glomerular filtration rate (eGFR) ＜ 60 mL/min per 1.73 m2,ejection fraction (EF) ＜ 45％,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump (IABP) implantation,postoperative low cardiac output syndrome (LCOS) and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to 32 points with three risk categories.The AKI frequencies were as follows:0-8 points (15.9％),9-17points (36.5％) and ≥ 18 points(90.4％).The area under of the ROC curve was 0.730 (95％ CI:0.691-0.768) in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735 (95％ CI:0.655-0.815).The model was well calib-rated according to the Hosmer-Lemeshow test (P =0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.