Predicting kidney injury after cardiac surgery with cardio-pulmonary bypass using machine learning

Introduction: Acute kidney injury after cardiac surgery (CSA-AKI) is a common complication after cardiac surgery and an independent predictor of morbidity and mortality. Since evidence-based care is based on risk mitigation and implementation of supportive measures, early risk stratification and consequent adjustment of treatment strategies are elemental. Artificial intelligence screening can aid in pre- and perioperative risk stratification. Methods: This is a secondary analysis of 130 prospectively recruited patients from one center of a multicenter observational trial that investigated the implementation of a bundle of supportive measures to prevent AKI in patients undergoing cardiac surgery with cardiopulmonary bypass. Machine learning (ML) enabled artificial intelligence (AI) was used to retrospectively analyze patients' electronic health record (EHR) data and generate an AKI risk estimate. The aim of this study was to investigate the feasibility of AI-based risk scores to predict AKI within 72 hours postoperatively and the development of acute kidney disease (AKD) at day 30 after surgery. Results: Of 130 patients, 33.1% developed CSA-AKI. Of 119 with 30-day follow-up data, 18.5% developed AKD. Day-of-surgery AI risk-scoring was evaluated with an AUROC of 0.79 for occurrence of CSA-AKI, postoperative risk predictions were evaluated with an AUROC of 0.83 for AKD at 30 days postoperatively. ANOVA testing revealed that patients who developed CSA-AKI or AKD had significantly higher predicted risk scores than those who did not, with large effect sizes. Predicted risk also increased significantly over the perioperative period in patients with adverse outcomes. Conclusions: Risk stratification with an ML-based AI approach based solely on EHR data provides a low-effort and high-yield screening method for identifying patients at risk of developing CSA-AKI and AKD. These findings indicate that an EHR (Electronic Health Record)-only model, trained on routine hospital data, provides clinically actionable discrimination in a real-world cardiac surgery cohort, supporting its use for early screening and targeted mitigation.