Analysis of novel predictors of acute kidney injury after non-cardiac surgery: an integrative review.

Authors

Anna Carolina de Rizzo Cantoni Rosa, Petherson Mendonça Dos Santos, Beatriz Moreira Silva, Eduardo Cantoni Rosa, Miguel Angelo Goes

Published in

Jornal brasileiro de nefrologia. Volume 48. Issue 4. Pages e20250347.

Abstract

Acute kidney injury (AKI) is a common postoperative complication (postoperative AKI, [PO-AKI]), occurring in up to 35% of non-cardiac surgery. Some biomarkers have shown value in early identification but are underused in clinical practice due to their high cost. The SPARK score and the hemoglobin-to-red cell distribution width ratio (Hb/RDW) have emerged as accessible alternatives for predicting PO-AKI.
To evaluate studies on SPARK predictors and hematological biomarkers for risk stratification of PO-AKI in non-cardiac surgery.
An integrative review was conducted across four databases (PubMed/MEDLINE, LILACS, Embase, and Web of Science), covering publications between 2019 and 2025 in Portuguese and English. Studies including adults undergoing non-cardiac surgery were included. The selection process was documented using a PRISMA 2020 flow diagram.
Six studies were included. The SPARK score showed an AUC ranging from 0.69 to 0.81 in external validations, with superior performance in modified models for specific populations. The Hb/RDW index demonstrated good accuracy (AUC 0.714; sensitivity 72.7%; specificity 70.8%) in elderly orthopedic patients, with lower values associated with increased risk of PO-AKI.
The effectiveness of SPARK depends on the population profile, highlighting the importance of external validation and contextual adjustments. Hb, RDW, and the Hb/RDW ratio appear to be promising tools to complement SPARK.
The application of SPARK may be limited in different contexts. Simple biomarkers such as Hb, RDW, and Hb/RDW show good predictive potential and may improve the early identification of patients at risk for PO-AKI.

PMID:
42696267
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

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