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Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan.
J Am Coll Cardiol. 2016 Apr 12; 67(14):1715-22.JACC

Abstract

BACKGROUND

Stratifying patient risk for acute kidney injury (AKI) prior to percutaneous coronary intervention (PCI) can enable clinicians to tailor their approach to minimize AKI. The National Cardiovascular Data Registry (NCDR) CathPCI Registry recently developed 2 prediction models: for AKI and AKI requiring dialysis (AKI-D).

OBJECTIVES

This study sought to externally validate the NCDR AKI and AKI-D models in a Japanese population. Determining the generalizability of the U.S. model could support quality improvement efforts in Japan.

METHODS

The NCDR prediction models were applied to 11,041 consecutive patients in the Japanese multicenter PCI registry. AKI was defined as an absolute increase ≥ 0.3 mg/dl or a relative increase of 50% in serum creatinine, in accordance with the definition of AKI Network criteria; AKI-D was defined as initiation of dialysis after PCI. Discrimination and calibration of the NCDR models were tested in the Japanese cohort. If the model was perfectly calibrated, the slope and intercept would equal 1.0 and 0.0, respectively.

RESULTS

In the Japanese PCI cohort, AKI and AKI-D occurred in 10.5% and 1.5% of patients, respectively. The NCDR AKI prediction model showed good discrimination (c-statistic = 0.76) and calibration (slope = 0.93 and intercept = -0.10) in both acute and nonacute PCI. The AKI-D prediction model had good discrimination (c-statistic = 0.92), but while the calibration slope was good (1.04), the intercept was significantly underestimated (0.96). However, this was corrected with recalibration (slope = 1.04 and intercept = -0.087).

CONCLUSIONS

In a Japanese population, the NCDR AKI models validly predict post-procedural AKI and, with recalibration, AKI-D. Prospective use of these models to inform clinical decision making should be tested as a means of reducing AKI after PCI in Japan. (Japan Cardiovascular Database, Percutaneous Coronary Intervention Registry; UMIN R000004736).

Authors+Show Affiliations

Department of Cardiology, Keio University School of Medicine, Tokyo, Japan; Department of Cardiology, Hiratsuka City Hospital, Hiratsuka, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: kohsaka@cpnet.med.keio.ac.jp.Department Health Policy and Management, Keio University School of Medicine, Tokyo, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.Denver VA Medical Center, Denver, Colorado.Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

27056778

Citation

Inohara, Taku, et al. "Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan." Journal of the American College of Cardiology, vol. 67, no. 14, 2016, pp. 1715-22.
Inohara T, Kohsaka S, Miyata H, et al. Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan. J Am Coll Cardiol. 2016;67(14):1715-22.
Inohara, T., Kohsaka, S., Miyata, H., Ueda, I., Maekawa, Y., Fukuda, K., Cohen, D. J., Kennedy, K. F., Rumsfeld, J. S., & Spertus, J. A. (2016). Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan. Journal of the American College of Cardiology, 67(14), 1715-22. https://doi.org/10.1016/j.jacc.2016.01.049
Inohara T, et al. Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan. J Am Coll Cardiol. 2016 Apr 12;67(14):1715-22. PubMed PMID: 27056778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan. AU - Inohara,Taku, AU - Kohsaka,Shun, AU - Miyata,Hiroaki, AU - Ueda,Ikuko, AU - Maekawa,Yuichiro, AU - Fukuda,Keiichi, AU - Cohen,David J, AU - Kennedy,Kevin F, AU - Rumsfeld,John S, AU - Spertus,John A, PY - 2015/12/21/received PY - 2016/01/27/revised PY - 2016/01/28/accepted PY - 2016/4/9/entrez PY - 2016/4/9/pubmed PY - 2016/8/16/medline KW - external validation KW - percutaneous coronary intervention KW - risk model KW - serum creatinine SP - 1715 EP - 22 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 67 IS - 14 N2 - BACKGROUND: Stratifying patient risk for acute kidney injury (AKI) prior to percutaneous coronary intervention (PCI) can enable clinicians to tailor their approach to minimize AKI. The National Cardiovascular Data Registry (NCDR) CathPCI Registry recently developed 2 prediction models: for AKI and AKI requiring dialysis (AKI-D). OBJECTIVES: This study sought to externally validate the NCDR AKI and AKI-D models in a Japanese population. Determining the generalizability of the U.S. model could support quality improvement efforts in Japan. METHODS: The NCDR prediction models were applied to 11,041 consecutive patients in the Japanese multicenter PCI registry. AKI was defined as an absolute increase ≥ 0.3 mg/dl or a relative increase of 50% in serum creatinine, in accordance with the definition of AKI Network criteria; AKI-D was defined as initiation of dialysis after PCI. Discrimination and calibration of the NCDR models were tested in the Japanese cohort. If the model was perfectly calibrated, the slope and intercept would equal 1.0 and 0.0, respectively. RESULTS: In the Japanese PCI cohort, AKI and AKI-D occurred in 10.5% and 1.5% of patients, respectively. The NCDR AKI prediction model showed good discrimination (c-statistic = 0.76) and calibration (slope = 0.93 and intercept = -0.10) in both acute and nonacute PCI. The AKI-D prediction model had good discrimination (c-statistic = 0.92), but while the calibration slope was good (1.04), the intercept was significantly underestimated (0.96). However, this was corrected with recalibration (slope = 1.04 and intercept = -0.087). CONCLUSIONS: In a Japanese population, the NCDR AKI models validly predict post-procedural AKI and, with recalibration, AKI-D. Prospective use of these models to inform clinical decision making should be tested as a means of reducing AKI after PCI in Japan. (Japan Cardiovascular Database, Percutaneous Coronary Intervention Registry; UMIN R000004736). SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/27056778/Performance_and_Validation_of_the_U_S__NCDR_Acute_Kidney_Injury_Prediction_Model_in_Japan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(16)00509-X DB - PRIME DP - Unbound Medicine ER -