AKI-Pro score for predicting progression to severe acute kidney injury or death in patients with early acute kidney injury after cardiac surgery

• Published in: Journal of translational medicine 2024-06, Vol.22 (1), p.571-10, Article 571
• Main Authors: Su, Ying, Wang, Peng, Hu, Yan, Liu, Wen-Jun, Zhang, Yi-Jie, Chen, Jia-Qi, Deng, Yi-Zhi, Lin, Shuang, Qiu, Yue, Li, Jia-Kun, Chen, Chen, Tu, Guo-Wei, Luo, Zhe
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Aged; AKI progression; Cardiac patients; Cardiac Surgical Procedures - adverse effects; Cohort Studies; Disease Progression; Female; Furosemide; Furosemide stress test; Humans; Male; Medical research; Medicine, Experimental; Middle Aged; Modified Furosemide responsiveness index; Predictive score; Prognosis; Renal replacement therapy; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index
• ISSN: 1479-5876; 1479-5876
• DOI: 10.1186/s12967-024-05279-4

No reliable clinical tools exist to predict acute kidney injury (AKI) progression. We aim to explore a scoring system for predicting the composite outcome of progression to severe AKI or death within seven days among early AKI patients after cardiac surgery. In this study, we used two independent cohorts, and patients who experienced mild/moderate AKI within 48 h after cardiac surgery were enrolled. Eventually, 3188 patients from the MIMIC-IV database were used as the derivation cohort, while 499 patients from the Zhongshan cohort were used as external validation. The primary outcome was defined by the composite outcome of progression to severe AKI or death within seven days after enrollment. The variables identified by LASSO regression analysis were entered into logistic regression models and were used to construct the risk score. The composite outcome accounted for 3.7% (n = 119) and 7.6% (n = 38) of the derivation and validation cohorts, respectively. Six predictors were assembled into a risk score (AKI-Pro score), including female, baseline eGFR, aortic surgery, modified furosemide responsiveness index (mFRI), SOFA, and AKI stage. And we stratified the risk score into four groups: low, moderate, high, and very high risk. The risk score displayed satisfied predictive discrimination and calibration in the derivation and validation cohort. The AKI-Pro score discriminated the composite outcome better than CRATE score, Cleveland score, AKICS score, Simplified renal index, and SRI risk score (all P