What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary artery bypass graft (CABG) surgery (n=8363). Intervention: Preoperative patient characteristics. Primary outcome: Severe renal insufficiency (GFR <30 mL/min/1.73 m2) (ROC 0.72, 95% CI 0.68-0.75, p=<0.0001).

What does this research mean for the field?

A multivariable risk model using preoperative clinical characteristics accurately predicts the development of severe postoperative renal insufficiency in cardiac surgery patients with baseline normal or near-normal renal function. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 10, 2007Circulation

Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

Q: What are the key findings of this study?

A multivariable prediction model using preoperative characteristics discriminated the risk of developing severe renal insufficiency after CABG surgery (ROC 0.72; 95% CI 0.68-0.75; P<0.0001).

Q: What does this research mean for the field?

A multivariable risk model using preoperative clinical characteristics accurately predicts the development of severe postoperative renal insufficiency in cardiac surgery patients with baseline normal or near-normal renal function. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To develop and validate a multivariable prediction rule estimating the patient-specific risk of developing severe postoperative renal insufficiency following coronary artery bypass graft surgery in patients with normal baseline renal function.

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Key result

Preoperative risk model moderately predicts severe renal insufficiency after CABG with an AUC of ~0.72.

ROC 0.72
95% CI 0.68-0.75
P<0.0001
n=8,363

Why the study?

Renal insufficiency after CABG surgery is associated with increased mortality, and preoperative patient characteristics may predict postoperative renal insufficiency risk.

Can preoperative patient characteristics predict the risk of developing severe postoperative renal insufficiency after isolated CABG surgery?

Population

8,363 patients with normal or near-normal renal function undergoing isolated CABG in northern New England

Comparison

Patients with varying preoperative risk factors for postoperative severe renal insufficiency

Design

Prospective cohort study with multivariable logistic regression prediction model

Follow-up

Postoperative period

Authors

JBJeremiah R. BrownGeneral / Preventive / Lipids RCRichard P. CochranUniversity of Maine BLBruce J. LeavittUniversity of Vermont Medical Center

Discussion

Member takes

Implication

May aid preoperative risk stratification after CABG; leaves open prospective validation and outcome impact.

Key Points

To develop and validate a multivariable prediction rule estimating the patient-specific risk of developing severe postoperative renal insufficiency following coronary artery bypass graft surgery in patients with normal baseline renal function.
Prospectively evaluated 11,301 patients undergoing isolated CABG in northern New England between 2001 and 2005, excluding those with baseline moderate or severe renal insufficiency (GFR <60 mL/min/1.73 m2) to analyze a cohort of N=8,363.
Used multiple logistic regression to build a risk model for severe postoperative renal insufficiency (GFR <30 mL/min/1.73 m2), validating performance with bootstrap-corrected area under the ROC curve and the Hosmer-Lemeshow statistic.
Severe renal insufficiency developed postoperatively in 3% (229/8,363) of patients presenting with normal baseline kidney function.
Key independent multivariable predictors included older age, female gender, preoperative white blood cell count >12,000, prior CABG, congestive heart failure, peripheral vascular disease, diabetes, hypertension, and preoperative intraaortic balloon pump support.
The predictive model demonstrated significant fit (chi-square 150.8, P < 0.0001) and good discrimination (ROC 0.72, 95% CI: 0.68 to 0.75) alongside sound calibration.

Study Design

Type

Cohort (n=8,363)

Multicenter

Yes

Structured PICO

Can preoperative patient characteristics predict the risk of developing severe postoperative renal insufficiency after isolated CABG surgery?

Population

8,363 patients undergoing isolated CABG surgery with normal or near-normal preoperative renal function, evaluated for the development of severe postoperative renal insufficiency.

Exposure

Preoperative multivariable prediction model (including age, gender, WBC >12,000, prior CABG, congestive heart failure, peripheral vascular disease, diabetes, hypertension, and preoperative intraaortic balloon pump)

Outcome

Development of severe postoperative renal insufficiency (GFR <30 mL/min/1.73 m2)surrogate

Main Result

Effect estimate: ROC 0.72 (95% CI 0.68-0.75)

p-value: p=<0.0001

A multivariable prediction model using routine preoperative characteristics can identify patients at high risk of developing severe renal insufficiency after CABG surgery.

Cite This Study

Brown et al. (2007) conducted a cohort in Coronary artery bypass graft (CABG) surgery (n=8,363). Preoperative patient characteristics was evaluated on Severe renal insufficiency (GFR <30 mL/min/1.73 m2) (ROC 0.72, 95% CI 0.68-0.75, p=<0.0001). A multivariable prediction model using preoperative characteristics discriminated the risk of developing severe renal insufficiency after CABG surgery (ROC 0.72; 95% CI 0.68-0.75; P<0.0001).

synapsesocial.com/papers/6a6bb77b109fb9aed0244b25 https://doi.org/10.1161/circulationaha.106.677070

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Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Multivariable Prediction of Renal Insufficiency Developing After Cardiac Surgery

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider