A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention

• Published in: Catheterization and cardiovascular interventions Vol. 83; no. 1; pp. E8 - E16
• Main Authors: Chen, Yong-Li, Fu, Nai-Kuan, Xu, Jing, Yang, Shi-Cheng, Li, Shanshan, Liu, Yuan-Yuan, Cong, Hong-Liang
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.01.2014; Wiley Subscription Services, Inc
• Subjects: acute kidney injury; Acute Kidney Injury - blood; Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnosis; Acute Kidney Injury - mortality; Acute Kidney Injury - therapy; Aged; Biomarkers - blood; China - epidemiology; contrast; Contrast Media - adverse effects; Creatinine - blood; Decision Support Techniques; Health risk assessment; Heart attacks; Hospital Mortality; Humans; Incidence; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - mortality; Predictive Value of Tests; Prognosis; Renal Dialysis; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; score; Time Factors; China; score; percutaneous coronary intervention; acute kidney injury; contrast
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25109

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. © 2013 Wiley Periodicals, Inc.