Abstract OBJECTIVES Early prediction is crucial for cardiac surgery-associated acute kidney injury (CSA-AKI). We aimed to develop and validate a simple, clinical and laboratory-based risk score system for better CSA-AKI prediction. METHODS We developed a new pre-operative risk score system for moderate-to-severe CSA-AKI in a 10-year cohort of patients undergoing coronary artery bypass grafting at one tertiary center. Most predictive laboratory and clinical variables were identified and constituted a simple and a full model. External testing was performed in patients at another center. The risk score system was compared with two established clinical models. RESULTS The overall cohort comprised 27534, 6403, and 1733 patients with moderate-to-severe CSA-AKI rates of 3.3%, 2.8%, and 8.4% for training, validation, and external testing, respectively. A simple 6-variable AB2C-S2 score (Age, Biomarkers of N-terminal pro-B-type natriuretic peptide and hemoglobin, Clinical history of preoperative critical state, Surgical factors of isolated surgery and on-pump surgery) and a full 9-variable AB2C2-S4 score (AB2C-S2 score plus hypertension, urgent surgery, and previous surgery) were developed. The simple model achieved similar performance as the full model in validation (area under the receiver-operating characteristic curve AUC 0.78 vs 0.79, P = 0.37) and external testing (AUC 0.74 vs 0.75, P = 0.17), and both significantly outperformed than two established clinical models: Cleveland Clinic model (validation: AUC 0.71, external testing: AUC 0.65, all P 0.001) and Ng model (validation: AUC 0.64, external testing: AUC 0.65, all P 0.001). CONCLUSIONS A simple preoperative risk score system for moderate-to-severe CSA-AKI was developed and outperformed established complex clinical models.
Su et al. (Wed,) studied this question.