AKICS模型预测我国老年患者心脏术后急性肾损伤的价值

目的评估AKICS模型在我国老年心脏手术患者，预测术后急性肾损伤（acute kidney injury，AKI）的价值。方法回顾性收集广东省人民医院2007年1月至2009年12月行瓣膜或（和）冠脉搭桥手术的老年患者（年龄≥65岁）的临床资料。采用RIFLE标准诊断的AKI作为观察终点。分别在老年心脏手术患者和手术前7d内未造影的患者，用接受者工作特征（receuver ioeratubg characterist，ROC）曲线下面积和Hosmer—Lemeshow goodness—of—fittest检验模型的判别性与拟合度。结果共收集227例老年心脏手术患者的资料，其中141例患者术前7d未造影。在227例老年心脏手术患者，AKI发生率为63．9％（n=145），AKICS模型预测术后AKI的ROC曲线下面积为0．702（95％C10．631～0．772），拟合度检验为0．704；在术前7d未造影的141例患者，94例（66．7％）发生AKI，ROC曲线下面积为0．764（95％C10．684~0．844），拟合度检验为0．906。结论AKICS模型可预测我国老年患者心脏手术后AKI的发生，在手术前7d内未造影的老年心脏手术患者，其预测价值更高。

The value of AKICS score for the prediction of acute kidney injury after cardiac surgery in Chinese elderly patients

Objective The purpose of present study was to extemally validate AKICS score for acute kidney injury （AKI） after cardiac surgery in Chinese elderly patients. Method We conducted a retrospective research in patients undergoing coronary artery bypass grafting surgery and （or） valve replacement in our center between January 1, 2007 and December 31,2009. The primary outcome was AKI according to RIFLE criteria. The baseline serum ereatinine was defined as the latest serum creatinine before surgery. For evaluation of the performance of the model, discrimination and calibration of AKICS score were measured in elderly patients undergoing surgery and those who did not expose contrast media within 7 days prior to surgery. Results Among 227 patients included in the present study, 141 patients did not expose contrast media within 7 days before surgery. In the 227 elderly patients and the 141 patients who did not expose contrast media within 7 days before surgery, the incidence of AKI was 63.9% （145/227） and 66.7% （94/141）, respectively. In the 227 elderly patients, the discrimination of score using the area under the receiver operating characteristic （ROC） curve was 0.702 （95%CI 0.631 ~0.772）, and the calibration using Hosmer-Lemeshow goodness- of-fit test was 0.704. In the 141 patients who did not expose contrast media within 7 days before surgery, the area under ROC was 0.764 （95% CI 0.684 0.844）, and the calibration was 0.906. Conclusion AKICS score offers better performance and accurately predicts AKI according to RIFLE criteria in elderly patients undergoing cardiac surgery. Thisscoring model is more suitable for elderly patients who did not expose contrast media within 7 days before cardiac surgery.