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A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention.
Catheter Cardiovasc Interv 2014; 83(1):E8-16CC

Abstract

OBJECTIVE

To develop a simple scoring system based on preprocedural clinical features that is capable of predicting contrast-induced acute kidney injury (CI-AKI) before percutaneous coronary intervention (PCI).

BACKGROUND

CI-AKI is associated with increased in-hospital morbidity and mortality, prolonged hospitalization, and long-term renal impairment. Although several scoring methods have been developed to determine risk of CI-AKI, no simple scoring method based on PCI preprocedural clinical features yet exists for Chinese patients.

METHODS

A total of 2,500 Chinese patients were randomly and retrospectively assigned in a 3:2 manner to create a training and validation dataset, respectively. CI-AKI was defined as an increase of ≥25% or ≥0.5 mg/dL serum creatinine within 5 days after PCI. Preprocedural clinical variables showing independent correlation to CI-AKI were used to derive the risk score from the training dataset and then subsequently tested in the validation dataset. The odds ratios from multivariate logistic regression were used to assign a weighted integer to age ≥70 years = 4, history of myocardial infarction = 5, diabetes mellitus = 4, hypotension = 6, left ventricular ejection fraction ≤45% = 4, anemia = 3, creatinine clearance rate <60 mL/min = 7, decreased high-density lipoprotein <1 mmol/L= 3, and urgent PCI = 3. Summation of the integers represented the total risk score.

RESULTS

The overall incidence of CI-AKI in the training dataset was 16.4% [246/1500; 5.4% for low (≤7) and 61.3% for very high (≥17) risk scores]. The rates of CI-AKI, 1-year dialysis, and 1-year mortality increased significantly with each group (Cochran-Armitage test of trend, P < 0.001). The risk score facilitated appropriate classification of patients with low and high risk for CI-AKI after PCI in the validation dataset (c-statistic = 0.82).

CONCLUSION

Risk classification based on the most significantly correlated parameters is useful for predicting CI-AKI before contrast exposure. The simple preprocedural score showed excellent predictive ability for identifying patients at high risk of nephropathy and those with deteriorative prognosis after PCI.

Authors+Show Affiliations

Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

23907993

Citation

Chen, Yong-Li, et al. "A Simple Preprocedural Score for Risk of Contrast-induced Acute Kidney Injury After Percutaneous Coronary Intervention." Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, vol. 83, no. 1, 2014, pp. E8-16.
Chen YL, Fu NK, Xu J, et al. A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention. Catheter Cardiovasc Interv. 2014;83(1):E8-16.
Chen, Y. L., Fu, N. K., Xu, J., Yang, S. C., Li, S., Liu, Y. Y., & Cong, H. L. (2014). A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention. Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 83(1), pp. E8-16. doi:10.1002/ccd.25109.
Chen YL, et al. A Simple Preprocedural Score for Risk of Contrast-induced Acute Kidney Injury After Percutaneous Coronary Intervention. Catheter Cardiovasc Interv. 2014 Jan 1;83(1):E8-16. PubMed PMID: 23907993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention. AU - Chen,Yong-Li, AU - Fu,Nai-Kuan, AU - Xu,Jing, AU - Yang,Shi-Cheng, AU - Li,Shanshan, AU - Liu,Yuan-Yuan, AU - Cong,Hong-Liang, Y1 - 2013/09/30/ PY - 2012/07/30/received PY - 2012/10/19/revised PY - 2013/06/28/accepted PY - 2013/8/3/entrez PY - 2013/8/3/pubmed PY - 2014/8/19/medline KW - acute kidney injury KW - contrast KW - percutaneous coronary intervention KW - score SP - E8 EP - 16 JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv VL - 83 IS - 1 N2 - OBJECTIVE: To develop a simple scoring system based on preprocedural clinical features that is capable of predicting contrast-induced acute kidney injury (CI-AKI) before percutaneous coronary intervention (PCI). BACKGROUND: CI-AKI is associated with increased in-hospital morbidity and mortality, prolonged hospitalization, and long-term renal impairment. Although several scoring methods have been developed to determine risk of CI-AKI, no simple scoring method based on PCI preprocedural clinical features yet exists for Chinese patients. METHODS: A total of 2,500 Chinese patients were randomly and retrospectively assigned in a 3:2 manner to create a training and validation dataset, respectively. CI-AKI was defined as an increase of ≥25% or ≥0.5 mg/dL serum creatinine within 5 days after PCI. Preprocedural clinical variables showing independent correlation to CI-AKI were used to derive the risk score from the training dataset and then subsequently tested in the validation dataset. The odds ratios from multivariate logistic regression were used to assign a weighted integer to age ≥70 years = 4, history of myocardial infarction = 5, diabetes mellitus = 4, hypotension = 6, left ventricular ejection fraction ≤45% = 4, anemia = 3, creatinine clearance rate <60 mL/min = 7, decreased high-density lipoprotein <1 mmol/L= 3, and urgent PCI = 3. Summation of the integers represented the total risk score. RESULTS: The overall incidence of CI-AKI in the training dataset was 16.4% [246/1500; 5.4% for low (≤7) and 61.3% for very high (≥17) risk scores]. The rates of CI-AKI, 1-year dialysis, and 1-year mortality increased significantly with each group (Cochran-Armitage test of trend, P < 0.001). The risk score facilitated appropriate classification of patients with low and high risk for CI-AKI after PCI in the validation dataset (c-statistic = 0.82). CONCLUSION: Risk classification based on the most significantly correlated parameters is useful for predicting CI-AKI before contrast exposure. The simple preprocedural score showed excellent predictive ability for identifying patients at high risk of nephropathy and those with deteriorative prognosis after PCI. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/23907993/A_simple_preprocedural_score_for_risk_of_contrast_induced_acute_kidney_injury_after_percutaneous_coronary_intervention_ L2 - https://doi.org/10.1002/ccd.25109 DB - PRIME DP - Unbound Medicine ER -