Predictive Power of the Association of Cardiothoracic Anesthetists Perioperative Risk of Blood Transfusion Score for...

The Association of Cardiothoracic Anesthetists Perioperative Risk of Blood Transfusion (ACTA-PORT) score was originally developed to predict the need for transfusion in cardiac surgery patients. Given the inter-relationship between perioperative hemodynamics, transfusion, and renal function, this study aimed to evaluate the ability of the ACTA-PORT score to predict cardiac surgery-associated acute kidney injury (CSA-AKI).

Prospective observational study.

Single institution, tertiary care hospital.

A total of 467 adult patients undergoing open-heart surgery with cardiopulmonary bypass between July and November 2024 were included. Patients with pre-existing renal dysfunction were excluded.

This study involved no deviations from standard clinical care; patients were managed according to institutional protocols, and only observational data were collected. The ACTA-PORT score was derived from routinely collected preoperative variables prior to surgery.

The primary outcome was the development of CSA-AKI as defined by Kidney Disease: Improving Global Outcomes criteria. CSA-AKI occurred in 178 patients (38.1%). Higher ACTA-PORT scores were significantly associated with the development of CSA-AKI (odds ratio, 1.07; 95% confidence interval, 1.03-1.12; p = 0.002). In multivariate analysis, advanced age, prolonged cross-clamp time, and emergency surgery were also independent predictors of CSA-AKI, whereas statin use and preserved ejection fraction were protective factors. Patients with CSA-AKI had significantly higher rates of intensive care unit complications, prolonged hospitalization, and 30-day mortality.

The ACTA-PORT score is a simple, preoperatively obtainable tool that may provide useful insight into CSA-AKI risk. Incorporating this score into preoperative risk-assessment protocols may aid in identifying high-risk patients and optimizing perioperative management.