Key result
SPARK score shows moderate predictive performance for postoperative acute kidney injury across external validations.
Why the study?
Acute kidney injury is a common postoperative complication after non-cardiac surgery, and accessible predictors like the SPARK score and hematological biomarkers need evaluation for risk stratification.
Do the SPARK score and the Hb/RDW ratio accurately predict postoperative acute kidney injury in adult patients undergoing non-cardiac surgery?
Systematic Review
Do the SPARK score and the Hb/RDW ratio accurately predict postoperative acute kidney injury in adult patients undergoing non-cardiac surgery?
Effect estimate: AUC ranging from 0.69 to 0.81 (SPARK) and 0.714 (Hb/RDW)
The SPARK score and Hb/RDW ratio show promise as accessible tools for early prediction and risk stratification of postoperative acute kidney injury in non-cardiac surgery, though population-specific adjustments may be necessary.
INTRODUCTION: Acute kidney injury (AKI) is a common postoperative complication (postoperative AKI, [PO-AKI]), occurring in up to 35% of non-cardiac surgery. Some biomarkers have shown value in early identification but are underused in clinical practice due to their high cost. The SPARK score and the hemoglobin-to-red cell distribution width ratio (Hb/RDW) have emerged as accessible alternatives for predicting PO-AKI. OBJECTIVE: To evaluate studies on SPARK predictors and hematological biomarkers for risk stratification of PO-AKI in non-cardiac surgery. METHODS: An integrative review was conducted across four databases (PubMed/MEDLINE, LILACS, Embase, and Web of Science), covering publications between 2019 and 2025 in Portuguese and English. Studies including adults undergoing non-cardiac surgery were included. The selection process was documented using a PRISMA 2020 flow diagram. RESULTS: Six studies were included. The SPARK score showed an AUC ranging from 0.69 to 0.81 in external validations, with superior performance in modified models for specific populations. The Hb/RDW index demonstrated good accuracy (AUC 0.714; sensitivity 72.7%; specificity 70.8%) in elderly orthopedic patients, with lower values associated with increased risk of PO-AKI. DISCUSSION: The effectiveness of SPARK depends on the population profile, highlighting the importance of external validation and contextual adjustments. Hb, RDW, and the Hb/RDW ratio appear to be promising tools to complement SPARK. CONCLUSION: The application of SPARK may be limited in different contexts. Simple biomarkers such as Hb, RDW, and Hb/RDW show good predictive potential and may improve the early identification of patients at risk for PO-AKI.
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Rosa et al. (2026) conducted a systematic review in Postoperative acute kidney injury in non-cardiac surgery. SPARK score and Hb/RDW ratio was evaluated on Postoperative acute kidney injury (PO-AKI) defined by KDIGO criteria (AUC ranging from 0.69 to 0.81 (SPARK) and 0.714 (Hb/RDW)). The SPARK score showed moderate predictive performance for postoperative acute kidney injury with an AUC ranging from 0.69 to 0.81 across external validations, while the Hb/RDW index showed an AUC of 0.714.
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