Title: Utility of Preoperative Risk Scoring to Predict Acute Kidney Injury (AKI) Following Cardiac Surgery
Authors: Lakshminarayana GR, Sheetal LG, Rajesh R, Anil M, George K, Shiv KN, Unni VN
DOI: http://dx.doi.org/10.18535/jmscr/v4i6.16
Acute kidney injury (AKI) is known to affect up to 30% of patients whoundergo cardiacsurgeries (CS). This study was done to estimate the incidence of AKI and AKI-D (AKI requiring dialysis) after CS and analyze the effectiveness of pre-operative scoring. All consecutive patients (1146, Males:952; Females:194), aged 18-82 years (Mean 55.90; SD:11.15) who underwent CS at AIMS, Kochi, Kerala, from May 2008 to April 2010 were included in the study. PostoperativeAKI was defined as >25% change in serum creatinine correspondingto a 20% reduction in Cockroft-Gault GFR from baseline withinone week after surgery. The overall incidence of AKI, AKI-D and mortality rate were 25.7, 2.1 and 2.18% respectively. The AKI risk categorization was done by using Cleveland Clinic Foundation score for CS. The frequency of AKI and AKI-D ranged between 13.05 to 92% and 0.24 to 28 %; in low to high risk categories of patients. The need for prolonged hospital stays (> 10 days) and mortality rates ranged between 38.18 to 64% and 0.49 to 20%, respectively, from low to high risk score categories. In multivariate analysis, gender, presence of COPD did not have significant effect and age >40 had a significant effect on AKI. In conclusion, AKI risk score correlated incidence rates of AKI, AKI-D, prolonged hospital stays and mortality. This study validates the ARF risk scoring system by Cleveland Clinic Foundation for the Indian population.We propose a modified risk scoring system for AKI, by including relevant parameters with statistical significance. Key words: AKI, AKI-D, cardiac surgery, risk scoring
Abstract
