Perioperative medicine & outcomes
Revised cardiac risk index in predicting cardiovascular complications in patients receiving chronic kidney replacement therapy undergoing elective general surgery
Authors' conclusion
The RCRI tool performed poorly and overestimated risk in patients on chronic dialysis, potentially misinforming patients and clinicians about the risk of elective surgery.
Study context
- Population
- Patients on chronic kidney replacement therapy (haemodialysis (HD), peritoneal dialysis (PD), home haemodialysis (HHD), kidney transplant) undergoing elective abdominal surgery, Australia and New Zealand, 2000–2015
- Participants
- 5,094 elective surgeries
- Outcome
- MACE (nonfatal MI, nonfatal stroke, non-fatal cardiac arrest, cardiovascular mortality); RCRI discrimination (AUROC)
- Follow-up
- 30 days
Methodological detailsregistry-linked cohort, data linkage, binational registry, 15-year period
- Registry-linked cohort
- Data linkage
- Binational registry
- 15-year period
Performance
As reported in the abstract
RCRI discrimination for 30-day MACE, overall
| Test or model | Area under the receiver operating curve (AUROC) |
|---|---|
| Revised Cardiac Risk Index (RCRI) | 0.67 |
Revised Cardiac Risk Index (RCRI)
Area under the receiver operating curve (AUROC)0.67
- Major adverse cardiovascular event (MACE) incidence
- 153 (3.0%)
Further findings
Discrimination by subgroup (subgroup)
- Age >65 years, AUROC
- 0.591
- Age <65 years, AUROC (moderate)
- 0.740
- Kidney transplant recipients, AUROC (moderate)
- 0.718
Expected-to-observed outcome ratio by RCRI score
- RCRI score 1
- 6.0
- RCRI score 2
- 5.1
- RCRI score ≥ 3
- 2.5
- Overestimation common but less so for kidney transplant recipients
Clinical utility (decision curve analysis, net benefit)
- Slight benefit in kidney transplant recipients at threshold probability
- > 5.5%
- No net benefit in overall cohort or patients under 65 years
Original publication
Revised cardiac risk index in predicting cardiovascular complications in patients receiving chronic kidney replacement therapy undergoing elective general surgery. Perioper Med (Lond). Published 10 July 2024. doi:10.
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