Key result
The ACEF II score demonstrated better discrimination than the ACEF score for predicting acute kidney injury requiring dialysis (AUC 0.718 vs 0.626) in Chinese adults undergoing cardiac surgery.
Why the study?
The study was conducted to evaluate the value of the ACEF II score in predicting postoperative hospital death and acute kidney injury requiring dialysis in Chinese patients undergoing cardiac surgery.
Does the ACEF II score improve prediction of postoperative hospital death and AKI-D compared to the ACEF score in Chinese patients undergoing cardiac surgery?
Cohort (n=9,748)
No
Does the ACEF II score improve prediction of postoperative hospital death and AKI-D compared to the ACEF score in Chinese patients undergoing cardiac surgery?
The ACEF II score provides better discrimination than the ACEF score for predicting in-hospital death and AKI requiring dialysis in Chinese patients undergoing non-elective cardiac surgery.
ACEF II may aid AKI-D risk stratification in Chinese cardiac surgery; leaves open prospective validation and outcome impact.
OBJECTIVE: To evaluate the value of the ACEF II score in predicting postoperative hospital death and acute kidney injury requiring dialysis (AKI-D) in Chinese patients. METHODS: This retrospective study included adult patients who underwent cardiopulmonary bypass open heart surgery between January 2010 and December 2015 at Guangdong Provincial People's Hospital. ACEF II was evaluated to predict in-hospital death and AKI-D using the Hosmer-Lemeshow goodness of fit test for calibration and area under the receiver operating characteristic (ROC) curve for discrimination in non-elective and elective cardiac surgery. RESULTS: A total of 9748 patients were included. Among them, 1080 underwent non-elective surgery, and 8615 underwent elective surgery. Mortality was 1.8% (177/9748). In elective surgery, the area under the ROC (AUC) of the ACEF II score was 0.704 (95% CI: 0.648-0.759), similar to the ACEF score of 0.709 (95% CI: 0.654-0.763). In non-elective surgery, the AUC of the ACEF II score was 0.725 (95% CI: 0.663-0.787), higher than the ACEF score (AUC = 0.625, 95% CI: 0.553-0.697). The incidence of AKI-D was 3.5% (345/9748). The AUC of the ACEF II score was 0.718 (95% CI: 0.687-0.749), higher than the ACEF score (AUC = 0.626, 95% CI: 0.594-0.658). CONCLUSION: ACEF and ACEF II have poor discrimination ability in predicting AKI-D in non-elective surgery. The ACEF II and ACEF scores have the same ability to predict in-hospital death in elective cardiac surgery, and the ACEF II score is better in non-elective surgery. The ACEF II score can be used to assess the risk of AKI-D in elective surgery in Chinese adults.
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Mo et al. (2022) conducted a cohort in Elective and non-elective cardiac surgery (n=9,748). ACEF II score vs. ACEF score was evaluated on Acute kidney injury requiring dialysis (AKI-D) 7 days postsurgery (AUC 0.718, 95% CI 0.687-0.749). The ACEF II score demonstrated better discrimination than the ACEF score for predicting acute kidney injury requiring dialysis (AUC 0.718 vs 0.626) in Chinese adults undergoing cardiac surgery.
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