Development of model to predict end-stage renal disease after coronary artery bypass grafting: The ACHE score

Medicine (Baltimore). 2019 May;98(21):e15789. doi: 10.1097/MD.0000000000015789.

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.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Acute Kidney Injury / complications
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Coronary Artery Bypass / adverse effects*
  • Female
  • Humans
  • Kidney Failure, Chronic / diagnosis*
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / mortality
  • Male
  • Middle Aged
  • Models, Statistical*
  • Multivariate Analysis
  • Postoperative Complications / diagnosis*
  • Postoperative Complications / etiology
  • Postoperative Complications / mortality
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / complications
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors

Substances

  • Antihypertensive Agents