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Published on: September 15, 2023
Development of model to predict end-stage renal disease after coronary artery bypass grafting: The ACHE score
Yeonhee Lee1, Jiwon Park2, Myoung-Jin Jang2
1Department of Internal Medicine, Seoul National University College of Medicine.
Insights
A new model predicts end-stage renal disease (ESRD) in coronary artery bypass grafting (CABG) patients. The ACHE score, using postoperative acute kidney injury, chronic kidney disease, and antihypertensive drugs, offers precise ESRD risk prediction.
Area of Science:
- Nephrology
- Cardiology
- Medical Informatics
Background:
- End-stage renal disease (ESRD) significantly increases morbidity and mortality risks.
- Early detection and prevention of ESRD are crucial in clinical practice.
- No validated ESRD prediction models exist for patients undergoing coronary artery bypass grafting (CABG).
Purpose of the Study:
- To develop and validate a risk-prediction model for ESRD in patients undergoing CABG.
- To identify key predictors of ESRD in this specific patient population.
Main Methods:
- Retrospective multicenter cohort study (2004-2015) involving 3089 CABG patients for model derivation.
- Cox proportional hazard analyses and stepwise selection multivariate analyses were used for model development.
- External validation was performed on an independent cohort of 279 patients.
Main Results:
- During a median 6-year follow-up, 2.0% of patients developed ESRD.
- The final ESRD prediction model included postoperative acute kidney injury, underlying chronic kidney disease, and the number of antihypertensive drugs (ACHE score).
- The model demonstrated strong predictive performance with C-statistics of 0.89 (development) and 0.82 (validation).
Conclusions:
- A simple and precise ESRD prediction model, the ACHE score, has been developed and validated for CABG patients.
- This model can aid in early risk stratification and potentially guide preventative strategies for ESRD in this cohort.
Abstract:
Because end-stage renal disease (ESRD) increases the risks of morbidity and mortality, early detection and prevention of ESRD is a critical issue in clinical practice. However, no ESRD-prediction models have been developed or validated in patients undergoing coronary artery bypass grafting (CABG).This is a retrospective multicenter cohort study, recruited between January 2004 and December 2015. A cohort of 3089 patients undergoing CABG in two tertiary referral centers was analyzed to derive a risk-prediction model. The model was developed using Cox proportional hazard analyses, and its performance was assessed using C-statistics. The model was externally validated in an independent cohort of 279 patients.During the median follow-up of 6 years (maximum 13 years), ESRD occurred in 60 patients (2.0%). Through stepwise selection multivariate analyses, the following three variables were finally included in the ESRD-prediction model: postoperative Acute kidney injury, underlying Chronic kidney disease, and the number of antiHypertensive drugs (ACHE score). This model showed good performance in predicting ESRD with the following C-statistics: 0.89 (95% confidence interval [CI] 0.84-0.94) in the development cohort and 0.82 (95% CI 0.60-1.00) in the external validation cohort.The present ESRD-prediction model may be applicable to patients undergoing CABG, with the advantage of simplicity and preciseness.
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