Sunho Ko1, Changwung Jo1, Hajeong Lee2, Du Hyun Ro3, Chong Bum Chang4, Yong Seuk Lee4, Young-Wan Moon5, Jae Woo Youm5, Hyuk-Soo Han6, Myung Chul Lee6. 1. Seoul National University College of Medicine, Seoul, South Korea. 2. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea. 3. Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. duhyunro@gmail.com. 4. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul, South Korea. 5. Department of Orthopedic Surgery, Samsung Medical Center, Seoul, South Korea. 6. Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
Abstract
PURPOSE: Acute kidney injury (AKI) is a deleterious complication after total knee arthroplasty (TKA). The purposes of this study were to identify preoperative risk factors and develop a web-based prediction model for postoperative AKI, and assess how AKI affected the progression to ESRD. METHOD: The study included 5757 patients treated in three tertiary teaching hospitals. The model was developed using data on 5302 patients from two hospitals and externally validated in 455 patients from the third hospital. Eighteen preoperative variables were collected and feature selection was performed. A gradient boosting machine (GBM) was used to predict AKI. A tenfold-stratified area under the curve (AUC) served as the metric for internal validation. Calibration was performed via isotonic regression and evaluated using a calibration plot. End-stage renal disease (ESRD) was followed up for an average of 41.7 months. RESULTS: AKI develops in up to 10% of patients undergoing TKA, increasing the risk of progression to ESRD. The ESRD odds ratio of AKI patients (compared to non-AKI patients) was 9.8 (95% confidence interval 4.3-22.4). Six key predictors of postoperative AKI were selected: higher preoperative levels of creatinine in serum, the use of general anesthesia, male sex, a higher ASA class (> 3), use of a renin-angiotensin-aldosterone system inhibitor, and no use of tranexamic acid (all p < 0.001). The predictive performance of our model was good (area under the curve 0.78 [95% CI 0.74-0.81] in the developmental cohort and improved in the external validation cohort (0.89). Our model can be accessed at https://safetka.net . CONCLUSIONS: A web-based predictive model for AKI after TKA was developed using a machine-learning algorithm featuring six preoperative variables. The model is simple and has been validated to improve both short- and long-term prognoses of TKA patients. Postoperative AKI may lead to ESRD, which surgeons should strive to avoid. LEVEL OF EVIDENCE: Diagnostic level II.
PURPOSE: Acute kidney injury (AKI) is a deleterious complication after total knee arthroplasty (TKA). The purposes of this study were to identify preoperative risk factors and develop a web-based prediction model for postoperative AKI, and assess how AKI affected the progression to ESRD. METHOD: The study included 5757 patients treated in three tertiary teaching hospitals. The model was developed using data on 5302 patients from two hospitals and externally validated in 455 patients from the third hospital. Eighteen preoperative variables were collected and feature selection was performed. A gradient boosting machine (GBM) was used to predict AKI. A tenfold-stratified area under the curve (AUC) served as the metric for internal validation. Calibration was performed via isotonic regression and evaluated using a calibration plot. End-stage renal disease (ESRD) was followed up for an average of 41.7 months. RESULTS: AKI develops in up to 10% of patients undergoing TKA, increasing the risk of progression to ESRD. The ESRD odds ratio of AKI patients (compared to non-AKI patients) was 9.8 (95% confidence interval 4.3-22.4). Six key predictors of postoperative AKI were selected: higher preoperative levels of creatinine in serum, the use of general anesthesia, male sex, a higher ASA class (> 3), use of a renin-angiotensin-aldosterone system inhibitor, and no use of tranexamic acid (all p < 0.001). The predictive performance of our model was good (area under the curve 0.78 [95% CI 0.74-0.81] in the developmental cohort and improved in the external validation cohort (0.89). Our model can be accessed at https://safetka.net . CONCLUSIONS: A web-based predictive model for AKI after TKA was developed using a machine-learning algorithm featuring six preoperative variables. The model is simple and has been validated to improve both short- and long-term prognoses of TKA patients. Postoperative AKI may lead to ESRD, which surgeons should strive to avoid. LEVEL OF EVIDENCE: Diagnostic level II.
Authors: Frederic T Billings; Patricia A Hendricks; Jonathan S Schildcrout; Yaping Shi; Michael R Petracek; John G Byrne; Nancy J Brown Journal: JAMA Date: 2016-03-01 Impact factor: 56.272
Authors: Philip J Belmont; Gens P Goodman; Brian R Waterman; Julia O Bader; Andrew J Schoenfeld Journal: J Bone Joint Surg Am Date: 2014-01-01 Impact factor: 5.284
Authors: Charles Hobson; Tezcan Ozrazgat-Baslanti; Adrienne Kuxhausen; Paul Thottakkara; Philip A Efron; Frederick A Moore; Lyle L Moldawer; Mark S Segal; Azra Bihorac Journal: Ann Surg Date: 2015-06 Impact factor: 12.969
Authors: Kang Liu; Xiangzhou Zhang; Weiqi Chen; Alan S L Yu; John A Kellum; Michael E Matheny; Steven Q Simpson; Yong Hu; Mei Liu Journal: JAMA Netw Open Date: 2022-07-01
Authors: Florian Hinterwimmer; Igor Lazic; Christian Suren; Michael T Hirschmann; Florian Pohlig; Daniel Rueckert; Rainer Burgkart; Rüdiger von Eisenhart-Rothe Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-01-10 Impact factor: 4.114