@article{4b9f503458ba4410b448dc9b477ef5c0,
title = "Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery",
abstract = "Background: Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies. Methods: The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study ({\textquoteleft}IMAGINE{\textquoteright}) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study ({\textquoteleft}Tayside{\textquoteright}) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI. Results: In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899). Conclusion: The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity.",
keywords = "Acute Kidney Injury/diagnosis, Cohort Studies, Digestive System Surgical Procedures/adverse effects, Humans, Kidney, Postoperative Complications/etiology, Prognosis, Prospective Studies, Retrospective Studies, Risk Assessment, Risk Factors",
author = "M. Thomas and M. Patel and P. Patel and D. Evans and I. Ibrahim and R. Smith and H. Amin and S. Lee and C. Doherty and M. Lim and M. Smith and Wong, {M. H.Y.} and C. Baker and J. McKenna and L. Sun and X. Wang and Yang, {D. D.} and E. Lewis and S. Lim and K. Ahmad and H. Liu and M. Jones and A. Ahmed and A. Ali and K. Ahmed and J. Lehmann and M. Hussain and M. Scott and J. Lee and N. Jones and M. Khan and S. Pillai and J. Davies and H. Robinson and M. Schramm and A. Khan and Cannon, {S. P.} and S. Sharma and Karim, {M. J.} and J. Henry and J. Turner and A. Rahman and E. Smith and K. Khan and Wong, {H. L.} and J. Frost and L. Jones and R. Brown and Hussain, {A. S.} and M. Tang and A. Haque and J. Martin and A. Patel and S. Ahmed and C. Wilson and J. Ward and W. Cheung and S. Lim and R. Kumar and He, {Y. Y.} and Karim, {M. J.} and K. Wang and H. Mann and H. Farooq and D. Thomas and M. Long and L. Walker and Zhu, {L. Y.} and J. Martin and C. Knight and Hussain, {S. F.} and S. Khan and H. Li and L. Williams and S. Sheikh and S. Husain and M. Ali and S. Kim and A. Tang and L. Wang and Y. Xu and T. Nguyen and Pedersen, {A. C.} and A. Herman and S. Anwar and Chu, {T. S.M.} and G. Davies and M. Williams and M. Vine and Shah, {S. M.} and M. Moore and J. Black and S. Brown and C. Williams and A. Saxena and S. Gurjar and L. Chen and F. Saeed and S. Small and A. Warsame and I. Ali and T. Brown and L. Watson and Hussain, {S. F.} and A. Thomas and M. Whyte and S. Green and Robinson, {S. D.} and Ward, {A. E.} and J. Cohen and R. Gupta and Wong, {M. H.Y.} and J. Birk and S. Ali and Tan, {T. S.E.} and E. Jones and R. Sivakumar and O. Hall and S. Edwards and D. Debnath and L. Lobo and M. Hossain and J. Jiang and Brown, {L. R.} and J. Thompson and Chen, {J. Y.} and M. Chan and C. Smith and H. Wang and M. Ho and S. Francis and J. Lund and S. Thomas and C. Harris and M. Farooq and B. Murphy and C. Morgan and Tan, {T. S.E.} and N. Tran and S. Shrestha and C. Gallagher and {De Freitas}, M. and S. Wright and M. Marks and P. Kan and C. Murray and S. Tan and N. Ahmed and J. Wilson and C. Lowe and N. Abbas and A. Jones and H. Ahmed and L. Williams and C. Warner and E. Wright and E. Thompson and A. Baker and R. Grant and Smith, {A. C.D.} and J. Reynolds and A. Mitra and Y. Zhang and Y. Chen and O. Thomas and S. Kirk and L. Lee and A. Frost and G. Lee and A. Ibrahim and A. Kler and Mohamed, {S. H.} and N. Lewis and D. Thomas and F. Ross and A. Al-Mousawi and K. Gill and Graham, {C. J.} and J. Cheng and M. Perera and H. Smith and L. Anderson and C. Gao and A. Prior and L. Nelson and N. Hall and R. Paramasivam and A. Martensen and Larsen, {H. M.} and A. Soares and S. Khan and A. Agarwal and M. Enevoldsen and S. Brandsborg and S. Amiri and Jepsen, {B. N.} and Erichsen, {S. B.} and Nielsen, {C. V.} and Aabling, {R. R.} and P. Dalsgaard and J. J{\"u}rgens-Lahnstein and M. Raos and S. Ravn and Lycke, {K. D.} and Kristensen, {F. P.} and K. B{\o}nnerup and Pohl, {L. J.} and F. Colombo and Garcia, {J. M.} and A. Singh and {STARSurg Collaborative and EuroSurg Collaborative}",
year = "2022",
doi = "10.1093/bjsopen/zrab150",
language = "English",
volume = "6",
journal = "BJS Open",
issn = "2474-9842",
publisher = "John Wiley & Sons Ltd",
number = "1",
}