Prediction of acute kidney injury after left ventricular assist device implantation: Evaluation of clinical risk scores.
Acute Kidney Injury
/ diagnosis
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Heart Failure
/ diagnosis
Heart-Assist Devices
Humans
Male
Middle Aged
Prosthesis Design
Prosthesis Implantation
/ adverse effects
Renal Replacement Therapy
Retrospective Studies
Risk Assessment
Risk Factors
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
acute kidney injury
left ventricular assist device
renal replacement therapy
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
14
05
2019
revised:
18
07
2019
accepted:
23
07
2019
pubmed:
31
7
2019
medline:
18
11
2020
entrez:
31
7
2019
Statut:
ppublish
Résumé
Acute kidney injury (AKI) is frequent in patients scheduled for implantation of a left ventricular assist device (LVAD) and associated with increased mortality. Although several risk models for the prediction of postoperative renal replacement therapy (RRT) have been developed for cardiothoracic patients, none of these scoring systems have been validated in LVAD patients. A retrospective, single center analysis of all patients undergoing LVAD implantation between September 2013 and July 2016 was performed. Primary outcome was AKI requiring RRT within 14 days after surgery. The predictive capacity of the Cleveland Clinic Score (CCS), the Society of Thoracic Surgeons Score (STS), and the Simplified Renal Index Score (SRI) were evaluated. 76 patients underwent LVAD implantation, 19 patients were excluded due to preoperative RRT. RRT was associated with a prolonged ventilation time, length of stay on the ICU and 180 day mortality (14(60.9%) vs 6(17.6%), P < .01). Whereas the Thakar Score (7.43 ± 1.75 vs 6.44 ± 1.44, P = .02) and the Mehta Score (28.12 ± 15.08 vs 21.53 ± 5.43, P = .02) were significantly higher in patients with RRT than in those without RRT, the SRI did not differ between these groups (3.96 ± 1.15 vs 3.44 ± 1.05, P = .08). Using ROC analyses, CCS, STS, and SRI showed moderate predictive capacity for RRT with an AUC of 0.661 ± 0.073 (P = .040), 0.637 ± 0.079 (P = .792), and 0.618 ± 0.075 (P = .764), respectively, with comparable accuracy in the Delong test. Using univariate logistic regression analysis, only the De Ritis Ratio (OR 2.67, P = .034) and MELD (OR 1.11, P = .028) were identified as predictors of postoperative RRT. Risk scores which are predictive in general cardiac surgery cannot predict RRT in patients after LVAD implantation. Therefore, it seems to be necessary to develop a specific risk score for this patient population.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
162-173Informations de copyright
© 2019 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.
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