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논문분류	춘계학술대회 초록집
제목	The KDIGO criteria are superior predictors of mortality after non-cardiac major surgery compared to AKIN criteria.
저자	Seokwoo Park* 1, Seongkeun Park2, Kwangsoo Kim3, Dong Ki Kim1, Kwon Wook Joo1, Yon Su Kim1, Hyung-Jin Yoon4, Hajeong Lee1
출판정보	2016; 2016(1):
키워드	acute kidney injury, mortality
초록	Background: Postoperative acute kidney injury (AKI) is a serious adverse event which leads to higher mortality. Although several studies have been published on the subject, heterogeneous definitions of AKI makes it difficult to synthesize study results. Therefore, we evaluated which is superior between Kidney Disease: Improving Global Outcomes criteria (KDIGO) and Acute Kidney Injury Network criteria (AKIN) in predicting patient outcomes after noncardiac surgery. Methods: We included adult (age≥18 years) patients who received noncardiac major surgery in Seoul National University Hospital from 2004 to 2013. Major surgery was defined more than 1 hour duration. Baseline serum creatinine (Cr) was defined as an average of measurements for 3 months before surgery. We excluded patients with baseline Cr over 4 mg/dl or those on maintenance renal replacement therapy (RRT). AKI was diagnosed according to both KDIGO and AKIN based on Cr measurements and initiation of RRT in 14 days after surgery. Areas under the receiver operating characteristics curves (AUC) of both criteria were calculated. Results: Among a total of 58,919 cases, 4,092 (6.95%) were identified to be AKI by KDIGO which were composed of 3,377 stage I, 320 stage II and 395 stage III cases. On contrary, only 3,347 (5.68%) patients were identified by AKIN with 2,786 stage I, 214 stage II and 347 stage III cases. Although most were diagnosed by both criteria simultaneously, 955 KDIGO AKI (832 stage I, 85 stage II, 38 stage III) were missed by AKIN. In contrast, merely 210 AKI patients were diagnosed by AKIN alone. Overall, in-hospital mortality developed in 281 (4.7%) patients. A 30-day and 90-day mortality rate was 3.5% and 12.1%, respectively. Postoperative AKI by KDIGO was an independent risk factor for in-hospital (OR 3.02; 95% CI, 2.68-3.35 P < 0.001), 30-day (OR 2.50; 95% CI, 2.14-2.87; P < 0.001), and 90-day (OR 1.40; 95% CI, 1.21-1.59, P < 0.001) mortality. AKIN AKI was also significantly related with in-hospital (OR 3.21; 95% CI, 2.88-3.56 P < 0.001), 30-day (OR 2.92; 95% CI, 2.55-3.29; P < 0.001), and 90-day (OR 1.63; 95% CI, 1.42-1.83, P < 0.001) mortality. KDIGO AKI was associated with 68.7% of in-hospital, 65.6% of 30-day and 37.4% of 90-day mortalities, whereas AKIN AKI with 63.9%, 58.5% and 32.9%, respectively. AUCs of KDIGO were greater than those of AKIN for in-hospital (0.820; 95% CI, 0.791-0.850 vs. 0.800; 95% CI, 0.770-0.831), 30-day (0.804; 95% CI, 0.736-0.810 vs. 0.773; 95% CI, 0.736-0.810) and 90-day mortality (0.658; 95% CI, 0.639-0.676 vs. 0.641; 95% CI, 0.623-0.659). The differences between AUCs of KDIGO and AKIN were statistically significant in all 3 clinical outcomes, namely in-hospital (P = 0.002), 30-day (P < 0.001) and 90-day (P < 0.001) mortality. Conclusion: In the current study, postoperative AKI after noncardiac major surgery was an independent risk factor for in-hospital, 30-day and 90-day mortality. KDIGO were superior to AKIN in predicting mortality.
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