Epidemiologic studies need a unique operational definition of acute kidney injury
(AKI) to compare outcomes. We aimed to compare prognostic value of change in serum
creatinine with classification systems of AKI to predict 30day
mortality after heart
surgery. From VA database, 27410 eligible patients with stable baseline kidney function
who had heart surgery from 1999 to 2005 were selected. There was a graded increase in
mortality from stage A to stage C of all systems. Adjusted 30day
mortality odds ratio
starts to increase significantly after an acute rise ≥ 0.3 mg/dL of creatinine in CKD stages
1 and 2, and after 0.6 mg/dL increase in CKD stage 3. Area under ROC curve of change
of creatinine from baseline was significantly higher than those of classification systems
(P<0.001). In conclusion, compared to continuous increase of creatinine, classification
systems of AKI misestimate mortality risk by collapsing predictive, clinically important
data into categories.
University of Minnesota M.S. thesis. May 2010. Major: Clinical Research. Advisor: Hassan N. Ibrahim MD, MS. 1 computer file (PDF); vii, 66 pages, appendices 1-14. Ill. (some col.)
An optimized classification system of acute kidney injury for predicting the short-term mortality after open heart surgery; comparison of current classification systems..
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