Predicting cardiac surgery-associated acute kidney injury: The CRATE score

Area of Science:

• Cardiology
• Nephrology
• Surgical Outcomes

Background:

• Acute kidney injury (AKI) is a significant complication following cardiac surgery, associated with higher mortality rates.
• Patients undergoing cardiac surgery with cardiopulmonary bypass are at risk for developing AKI.
• Early identification of patients at risk for AKI is crucial for timely intervention and improved outcomes.

Purpose of the Study:

• To develop a novel, non-dialytic risk score for predicting acute kidney injury (AKI) in patients undergoing cardiac surgery.
• To identify independent risk factors associated with the development of AKI post-cardiac surgery.
• To validate the accuracy and reliability of the developed AKI risk score.

Main Methods:

• A cohort of 909 patients undergoing cardiac surgery with cardiopulmonary bypass was analyzed, with 810 meeting inclusion criteria.
• Patients were classified as having AKI using the RIFLE criteria, with 16.9% developing postoperative AKI.
• Preoperative, intraoperative, and ICU admission data were collected to identify univariate and multivariate associations with AKI risk, leading to the development of the CRATE score.

Main Results:

• The CRATE score was developed based on four independent risk factors: creatinine, EuroSCORE, lactate, and cardiopulmonary bypass time.
• The CRATE score demonstrated good predictive accuracy in the initial cohort, with an area under the curve (AUC) of 0.89.
• The score maintained good discrimination in an external validation cohort from two different hospitals, achieving an AUC of 0.81.

Conclusions:

• The CRATE score is an accurate and easily calculable tool for assessing AKI risk in cardiac surgery patients.
• The score utilizes affordable and routinely available variables, facilitating its integration into standard clinical practice.
• The CRATE score aids in the early identification of patients at risk for AKI, enabling proactive management strategies.