Risk prediction models for acute kidney injury after cardiac valve surgery: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Chengfeng ¹ , HOU Zhenzhen ¹ , FENG Zhenzhen ¹ ,  YANG Qin ²

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, P. R. China;
2. Department of ICU, Sichuan Provincial People's Hospital, Chengdu, 610072, P. R. China;

Corresponding author：

YANG Qin, Email: 20152160@qq.com

Keywords：

Cardiac valve surgery; acute kidney injury; prediction model; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202508051

Video：

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Objective To systematically evaluate the research quality and efficacy of prediction models for acute kidney injury (AKI) after heart valve surgery, screen key predictive factors, and provide evidence-based basis for clinical risk assessment. Methods Computer search was carried out in PubMed, Web of Science, EMBASE, Cochrane Library, Medline, China Biology Medicine Database, China National Knowledge Infrastructure, Wanfang Database, and VIP Database to collect studies on AKI prediction models after heart valve surgery published from January 2015 to July 2025. The PROBAST tool was used to evaluate the bias risk and applicability of the models, and the TRIPOD was used to assess the reporting quality. Meta-analysis was performed to integrate the effect sizes of high-frequency (≥3 times) predictive factors. Results A total of 24 studies (39 models) were included. Area under the curve (AUC) of the receiver operational characteristic curve was between 0.551 and 0.928, and the combined AUC was 0.77 (95%CI 0.72-0.82). The overall bias risk of the models was relatively high (100% of the studies had a high bias risk), only 2 studies conducted external validation, and the models in 10 studies were not validated. In terms of TRIPOD reporting quality, the overall reporting quality of 24 studies was low, with a compliance percentage (number of items) ranging from 36.36% to 77.27%. Meta-analysis showed that age (OR=1.041, P=0.006), diabetes (OR=1.64, P=0.001), hypertension (OR=2.529, P <0.001), blood transfusion (OR=1.49, P=0.001), cystatin C (OR=2.408, P=0.018), history of cardiac surgery (OR=2.585, P <0.001), atrial fibrillation (OR=1.33, P <0.001), and vascular complications (OR=1.22, P=0.008) were independent risk factors for postoperative AKI. Conclusion The clinical applicability of existing prediction models is limited, with high bias risk and low reporting quality, and the methodology needs to be optimized. Eight factors such as age and hypertension can be used as core indicators for postoperative AKI risk assessment. In the future, multicenter prospective studies should be carried out to develop more reliable prediction tools.

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2. 董念国, 曹红, 周廷文, 等. 心脏瓣膜病治疗进展. 临床心血管病杂志, 2022, 38(6): 429-432.Dong NG, Cao H, Zhou YW, et al. Progress in the treatment of heart valve disease. J Clin Cardiol, 2022, 38(6): 429-432.
3. 刘明波, 何新叶, 杨晓红, 等. 《中国心血管健康与疾病报告2023》概要(心血管疾病流行及介入诊疗状况). 中国介入心脏病学杂志, 2024, 32(10): 541-550.Liu MB, He XY, Yang XH, et al. Interpretation of report on cardiovascular health and diseases in China 2023. Chin J Interv Cardiol, 2024, 32(10): 541-550.
4. Banovic M, Rajani R. Editorial: advances in the imaging and treatment of valvular heart disease: “rising to the challenge”. Front Cardiovasc Med, 2023, 10: 1276202.
5. Aluru JS, Barsouk A, Saginala K, et al. Valvular heart disease epidemiology. Med Sci (Basel), 2022, 10(2): 32.
6. 郝星. 2023年中国心血管外科手术和体外循环数据白皮书. 中国体外循环杂志, 2024, 22(4): 259-262.He X. White book of Chinese cardiovascular surgery and extracorporeal circulation in 2023. Chin J Extracorp Circ, 2024, 22(4): 259-262.
7. 杨琳琳, 刘刚, 易锐, 等. 急性肾损伤风险预测方法的研究进展. 实用医学杂志, 2022, 38(18): 2367-2372.Yang LL, Liu G, Yi R, et al. Research progress on risk prediction of acute renal injury. J Pract Med, 2022, 38(18): 2367-2372.
8. 刘嘉龙, 郭文超, 滕娇, 等. 成人急性肾损伤患者连续性肾脏替代治疗管理的最佳证据总结. 中华急危重症护理杂志, 2024, 5(2): 172-180.Liu JL, Guo WC, Teng J, et al. Summary of best evidence for the management of continuous renal replacement therapy in adults with acute kidney injury. Chin J Emerg Crit Care Nurs, 2024, 5(2): 172-180.
9. Nadim MK, Forni LG, Bihorac A, et al. Cardiac and vascular surgery-associated acute kidney injury: the 20th international consensus conference of the ADQI (acute disease quality initiative) group. J Am Heart Assoc, 2018, 7(11): e008834.
10. 高绪霞, 马立萍, 马涵英, 等. 4878例心脏外科手术后患者急性肾损伤发生率及其危险因素分析. 中华肾脏病杂志, 2020, 36(5): 359-365.Gao XX, Ma LP, Ma HY, et al. Incidence of acute kidney injury following cardiac surgery and related risk factors in 4878 patients. Chin J Nephrol, 2020, 36(5): 359-365.
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Latest ArticlesRisk prediction models for acute kidney injury after cardiac valve surgery: A systematic review and meta-analysis

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