Abstract: TH-PO009
Simple Postoperative-AKI Risk (SPARK) Classification in Major Non-Cardiovascular Surgery
Session Information
- AKI: Epidemiology, Risk Factors, Prevention
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Cho, Hyunjeong, Chungbuk National University Hospital, Cheongju-si, ChungcheongBuk-Do, Korea (the Republic of)
- Park, Seokwoo, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Lee, Soojin, Seoul national university hospital, Seoul, Korea (the Republic of)
- Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (the Republic of)
- Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Joo, Kwon Wook, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
- Kim, Yon Su, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
Background
We aimed to develop a patient-oriented outcome-based postoperative acute kidney injury (PO-AKI) risk index and classification for planning PO-AKI monitoring before performing major non-cardiac surgery.
Methods
We performed an observational cohort study in two tertiary referral hospitals, each consisting a discovery and validation cohort. Patients who underwent a major non-cardiac operation (≥ 1 hour) were included. We fitted a proportional logistic regression model for an ordinal outcome consisting of the following three categories: no PO-AKI, low-stage AKI, and critical AKI. Critical AKI was defined as KDIGO AKI stage ≥ 2, post-AKI death, or renal failure within 90 days after surgery. PO-AKI events not fulfilling the definition of critical AKI were defined as low-stage AKI.
Results
A total of 50,792 and 39,537 patients were included in the discovery and validation cohorts, respectively. After building a robust model with variables that could be collected or estimated when surgery was scheduled, further simplification was performed. The final Simple PO-AKI RisK (SPARK) index included scores of the following ten variables: age, sex, eGFR, surgery duration, emergency operation, diabetes mellitus, renin-angiotensin-aldosterone system blockades, hypoalbuminemia, anemia, and hyponatremia. The calibration and discrimination results were acceptable. The AUC for low-stage AKI and critical AKI was 0.701 and 0.779 in the validation cohort. When we designated cutoff values to define four classifications, the incidences of the outcomes showed class-dependent increments.
Conclusion
The SPARK index and classification prior to surgery reflects not only the risk of PO-AKI but also the severity and patient-oriented outcomes associated with PO-AKI.