Predictive value of preoperative MELD-Ⅺ score in continuous renal replacement therapy for postoperative acute kidney injury

ZHANG Qian-qian; QIN Li-wei; YU Huan; Li Shu-jie; WANG Wei

doi:10.3969/j.issn.1672-5301.2024.10.011

Abstract：Objective To analyze the correlation between the preoperative model for end-stage liver disease excluding international normalized ratio(MELD-Ⅺ)score and continuous renal replacement therapy(CRRT)in adult patients with acute kidney injury(CAS-AKI)after cardiac surgery.Methods A total of 351 patients with CSA-AKI after cardiac surgery under cardiopulmonary bypass in TEDA International Cardiovascular Hospital from June 2017 to June 2023 were retrospectively collected.According to whether CRRT was performed,the patients were divided into CRRT group and conservative treatment group.The two groups were matched 1∶1 based on propensity score matching.Univariate analysis was used to compare the differences between the two groups,multivariate logistic regression analysis was used to analyze the risk factors of CAS-AKI treated with CRRT,and the area under the ROC curve was used to evaluate the predictive efficacy.Results A total of 74 patients underwent CRRT,and 74 pairs of patients were matched.After propensity score matching,there were no significant differences in age,gender,BMI,smoking history,drinking history,diabetes history,and hypertension history between the two groups.Univariate analysis showed that there were significant differences between the two groups in MELD-Ⅺ score,EuroSCORE score,preoperative uric acid,preoperative urea,preoperative neutrophil/white blood cell ratio(NLR),operation time,CPB time,aortic cross-clamping time,intraoperative potassium ion,intraoperative lactic acid,NYHA class＞Ⅲ,and perioperative IABP application.Into multiple logistic regression analysis showed that after preoperative MELD-Ⅺ high score(OR=1.176,95％CI 1.009-1.371,P=0.039),EuroSCORE scoring high(OR=1.670,95％CI 1.274-2.190,P＜0.001)were independent risk factors for CRRT in patients with CSA-AKI.The best cut-off values of MELD-Ⅺ score and EuroSCORE score were 10.7 and 5.5,respectively.The area under the ROC curve was 0.727 and 0.832,respectively.Conclusions High preoperative MELD-Ⅺ score and high preoperative EuroSCORE score are independent risk factors for CRRT in patients with CSA-AKI,and both of them have certain predictive value.The combined predictive value of MELD-Ⅺ and EuroSCORE is better than single index.Preoperative MELD-Ⅺ score ≥10.7 and EuroSCORE ≥5.5 should attract clinical attention.