Postoperative AKI Cardiac Surgery (AKICS) Calculator
- Postoperative AKI after Cardiac Surgery (AKICS): Explanation and Clinical Context
The AKICS score is a bedside tool derived and prospectively validated to predict acute kidney injury (AKI) after elective cardiac surgery. It integrates preoperative, intraoperative, and early postoperative information available at ICU admission: combined surgery (e.g., CABG plus valve), NYHA class ≥ 2, pre-operative serum creatinine > 1.2 mg/dL, early postoperative low cardiac output (need for ≥3 vasoactive drugs or IABP within 48 h), age > 65 years, cardiopulmonary bypass time > 120 min, pre-operative capillary glucose > 140 mg/dL, and early postoperative CVP > 14 cm H2O. Each factor contributes a weighted number of points (total 0–20). Risk strata correspond to approximate AKI risks of 1.5% (0–4), 4.3% (4.1–8), 9.1% (8.1–12), 21.8% (12.1–16), and 62.5% (16.1–20).
Intended Use
This score is intended for adults undergoing elective cardiac surgery and complements pre-operative models by incorporating immediate postoperative physiology. It should not be extrapolated to emergency surgery, aortic surgery, transplant, congenital procedures, or patients with baseline creatinine >3.0 mg/dL, which were excluded in the original cohort. Use clinical judgment alongside institutional thresholds for nephrology consult, hemodynamic optimization, glycemic control, transfusion strategy, and renal-protective measures.
Reference:
Palomba H, de Castro I, Neto ALC, Lage S, Yu L. Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney International. 2007;72:624–631.
Huen SC, Parikh CR. Predicting acute kidney injury after cardiac surgery. Ann Thorac Surg. 2012;93:337–347.
Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16:162–168.
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