MO307: Prognostic Value of Sea-Make Score in Predicting Major Adverse Kidney Events Among Adult Filipino Patients With Acute Kidney Injury

Abstract

Abstract BACKGROUND AND AIMS Acute kidney injury (AKI) is a prevalent complication among hospitalized patients worldwide and is associated with a high morbidity and mortality rate. The SEA-MAKE score is a scoring tool recently introduced to predict major adverse kidney events (MAKE), defined as need for renal replacement therapy, sustained loss of kidney function or death occurring within 28 days among AKI patients. The use of a predictive scoring tool for MAKE would help clinicians identify and risk-stratify patients early in the course of hospitalization, allowing aggressive provision of renoprotective measures and targeted treatment. The objective of this study was to evaluate the diagnostic performance of the SEA-MAKE score in determining MAKE among adult Filipino patients with acute kidney injury admitted in the ICU. METHOD This study utilized a single-center, retrospective, cohort study design, which reviewed records of adult patients with a diagnosis of acute kidney injury admitted at the intensive care unit of San Pedro Hospital from 2011 to 2020. Patients were excluded if they had underlying chronic kidney disease. The parameters under the SEA-MAKE score were assigned score points of 3 for low Glasgow coma scale, 1 for tachypnea, 1 for vasopressor use, 2 for intubation status, 2 for oliguria, 5 for serum creatinine rising ≥ 3 times, 3 for high blood urea nitrogen, 2 for low hematocrit, and 1 for thrombocytopenia. Our study evaluated the diagnostic performance of the SEA-make score by measuring its sensitivity, specificity, negative predictive value, positive predictive value and accuracy. The association between the score of seven and above with the presence of MAKE was analyzed using the Fisher exact test, while the evaluation of the cut-off score was done using the receiver operating characteristic curve. All tests were done at a 5% level of significance. RESULTS Of the 265 eligible cases analyzed, 181 (68%) developed MAKE and 84 (32%) fell under the non-MAKE group. These 181 (67.3%) patients met one or more criteria for MAKE: death (n = 126; 47.5%), need for renal replacement therapy (n = 46; 17.4%) and sustained loss of kidney function (n = 9; 3.4%). When the SEA-MAKE score was correlated with the actual presence of major adverse kidney events, the result was statistically significant (P < .01). Utilizing the cut-off score of seven, the SEA-MAKE score showed a sensitivity of 76.24% and a specificity of 76.24%, with a positive and negative predictive value of 86.25% and 59.05%, respectively. These results are comparable to the SEA-MAKE development cohort, which used the same cut-off value and yielded the sensitivity, specificity and positive predictive values of 75%, 76% and 84%, respectively [1]. CONCLUSION The SEA-MAKE score is capable of predicting major adverse kidney events among patients with acute kidney injury, and is a very simple and useful tool especially in resource-limited hospitals similar to our setting. In our study, the SEA-MAKE score showed a good predictive index for MAKE in the background of AKI. This is the first external validation study done for the SEA-MAKE score. However, a larger prospective cohort study design would yield results with a higher statistical significance.