Article Figures & Data
Figures
- Figure 1.
Frequency of acute renal failure (ARF) that requires dialysis corresponding to ARF score in test and validation data sets.
- Figure 2.
Frequency of ARF across risk categories in test and validation sets.
- Figure 3.
Receiver operating characteristic curve analysis for the test and validation sets.
Tables
- Table 1.
Logistic model parameter estimates, score points, and AUC for each risk factor included in the scoring modela
Risk Factor Estimate (CI) P Value Points AUC for Single Variable Female gender 0.48 (0.21–0.75) <0.001 1 55.3 Congestive heart failure 0.48 (0.20–0.76) <0.001 1 63.9 Left ventricular ejection fraction <35% 0.39 (0.07–0.71) 0.016 1 56.4 Preoperative use of IABP 1.08 (0.49–1.67) <0.001 2 52.6 COPD 0.70 (0.37–1.04) <0.001 1 54.8 Insulin-requiring diabetes 0.40 (0.05–0.76) 0.026 1 54.4 Previous cardiac surgery 0.54 (0.28–0.81) <0.001 1 57.5 Emergency surgery 1.13 (0.65–1.60) <0.001 2 54.3 Surgery type valve only 0.45 (0.10–0.80) 0.013 1 63.3 CABG + Valve 0.86 (0.53–1.19) <0.001 2 other cardiac surgeries 1.02 (0.56–1.49) <0.001 2 Preoperative creatinine 1.2 to <2.1 mg/dl 0.92 (0.64–1.21) <0.001 2 68.6 Preoperative creatinine ≥2.1 mg/dl 2.66 (2.28–3.04) <0.001 5 ↵a CI, confidence interval; AUC, area under the receiver operating characteristic curve; IABP, intra-aortic balloon pump; COPD, chronic obstructive pulmonary disease.
Risk Factors (Test Set: N = 15,838) ARF-Dialysis (N = 269) No ARF (N = 15,569) P Value Gender <0.001 female (n = 4877) 111 (41.3%) 4766 (30.6%) male (n = 10,961) 158 (58.7%) 10,803 (69.4%) Race 0.033 white (n = 14,142) 236 (87.7%) 13,906 (89.3%) black (n = 609) 17 (6.3%) 592 (3.8%) other (n = 1087) 16 (6.0%) 1071 (6.9%) Preoperative intra-aortic balloon pump <0.001 yes (n = 239) 18 (6.7%) 221 (1.4%) no (n = 15,599) 251 (93.3%) 15,348 (98.6%) Congestive heart failure <0.001 yes (n = 4,221) 145 (53.9%) 4076 (26.2%) no (n = 11,617) 124 (46.1%) 11,493 (73.8%) Ejection fraction <35% <0.001 yes (n = 1784) 64 (23.8%) 1,720 (11.1%) no (n = 14,054) 205 (76.2%) 13,849 (88.9%) Surgery <0.001 CABG (n = 8314) 87 (32.3%) 8227 (52.8%) valve surgery (n = 4068) 65 (24.2%) 4003 (25.7%) CABG + valve (n = 2594) 88 (32.7%) 2506 (16.1%) other cardiac surgery (n = 862) 29 (10.8%) 833 (5.4%) Previous cardiac surgery <0.001 yes (n = 3444) 98 (36.4%) 12,223 (78.5%) no (n = 12,394) 171 (63.6%) 3,346 (21.5%) Emergency surgery <0.001 yes (n = 474) 31 (11.5%) 443 (2.9%) no (n = 15,364) 238 (88.5%) 15,126 (97.2%) Diabetes mellitus <0.001 insulin requiring (n = 1392) 47 (17.5%) 1345 (8.6%) non-insulin requiring (n = 2465) 46 (17.1%) 2419 (15.5%) none (n = 11,981) 176 (65.4%) 11,805 (75.8%) Chronic obstructive pulmonary disease <0.001 yes (n = 1326) 48 (17.8%) 1278 (8.2%) no (n = 14,512) 221 (82.2%) 14,291 (91.8%) Peripheral vascular disease <0.001 yes (n = 1896) 57 (21.2%) 1839 (11.8%) no (n = 13,942) 212 (78.8%) 13,730 (88.2%) Cerebrovascular disease <0.001 yes (n = 2713) 76 (28.3%) 2637 (16.9%) no (n = 13,125) 193 (71.8%) 12,932 (83.1%) ↵a ARF, acute renal failure; CABG, coronary artery bypass grafting.
- Table 3.
Risk variables (continuous) in patients with or without ARF that required dialysis
Risk Factor (Test Set: N = 15,838) ARF-Dialysis (Mean [SD]) No ARF (Mean [SD]) P Value Age (yr) 66.7 (12.1) 63.6 (12.4) <0.001 Weight (kg) 78.9 (18.9) 81.0 (17.2) 0.077 Preoperative creatinine (mg/dl) 1.6 (0.9) 1.1 (0.4) <0.001 Cardiopulmonary bypass time (minutes) 149.7 (71.8) 100.7 (50.1) <0.001 Risk Factor Points Female gender 1 Congestive heart failure 1 Left ventricular ejection fraction <35% 1 Preoperative use of IABP 2 COPD 1 Insulin-requiring diabetes 1 Previous cardiac surgery 1 Emergency surgery 2 Valve surgery only (reference to CABG) 1 CABG + valve (reference to CABG) 2 Other cardiac surgeries 2 Preoperative creatinine 1.2 to <2.1 mg/dl (reference to 1.2) 2 Preoperative creatinine ≥2.1 (reference to 1.2) 5 ↵a Minimum score, 0; maximum score, 17.
- Table 5.
Frequency of ARF that required dialysis at various score levels in test and validation sets
ARF Score Test Data Set Validation Data Set N ARF-Dialysis 95% CI N ARF-Dialysis 0 2123 0.05% 0–0.26 2243 0.13% 1 2760 0.29% 0.13–0.57 2755 0.33% 2 3533 0.71% 0.46–1.04 3521 0.57% 3 2949 1.19% 0.83–1.65 2724 1.03% 4 1896 2.06% 1.47–2.8 2000 2.30% 5 1252 3.04% 2.16–4.14 1254 2.63% 6 685 6.42% 4.71–8.53 674 8.01% 7 323 9.6% 6.67–13.35 314 9.87% 8 173 9.83% 5.83–15.27 185 14.05% 9 82 21.95% 13.56–32.46 99 17.17% 10 40 12.5% 4.19–26.8 46 19.57% 11 14 21.43% 4.66–50.08 18 38.89% 12 7 57.14% 18.41–90.1 4 25.00% 13 1 100% 2.5–100 2 100% Risk categories 0–2 8416 0.4% 0.28–0.56 8519 0.4% 3–5 6097 1.8% 1.5–2.2 5978 1.8% 6–8 1181 7.8% 6.3–9.5 1173 9.5% 9–13 144 21.5% 15.1–29.1 169 21.3%
A Clinical Score to Predict Acute Renal Failure after Cardiac Surgery
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