Misericordia e Dolce Hospital, Prato, Italy.
J Cardiovasc Med (Hagerstown). 2010 Jun;11(6):444-9. doi: 10.2459/JCM.0b013e328335227c.
To develop a simplified scoring system based on preprocedure clinical characteristics to predict contrast-induced nephropathy (CIN) before elective coronary angiography and percutaneous coronary intervention (PCI).
CIN is associated with increased mortality and morbidity following coronary angiography and PCI and accounts for increased hospital costs.
Several baseline clinical characteristics of 1218 patients were considered as candidate univariate predictors of CIN (increase > or =0.5 mg/dl in serum creatinine within 5 days after contrast exposure). On the basis of the odds ratio at multivariate logistic regression, seven markers (with weighted scores) were identified as independent correlates of CIN: age at least 73 years (1), diabetes mellitus (2), left ventricular ejection fraction 45% or less (2), baseline serum creatinine value at least 1.5 mg/dl (2), baseline creatinine clearance 44 ml/min or less (2), posthydration creatinine > or = prehydration creatinine value (2) and one procedure effected within the past 72 h (3).
CIN occurred in 114 (9.4%) patients [range 1.1-52.1% for a low (< or =3) and very high (> or =9) risk score, respectively]; the odds of CIN increased significantly with each class (Cochran-Armitage chi-square, P < 0.0001) and the risk score allowed us to determine patients with low and high risk for postprocedure CIN (c-statistic = 0.86). These results were reproduced in a validation set.
Preprocedural clinical risk factors have different influences on the likelihood of CIN. Risk classification based on the most significant parameters can be used to predict CIN before contrast exposure. The simple scoring system proposed here provides a good estimate of the risk of CIN, allowing the interventional team to make adequate adjustment to the procedures.
建立一种基于术前临床特征的简化评分系统，用于预测择期冠状动脉造影及经皮冠状动脉介入治疗（PCI）前的对比剂肾病（CIN）。
CIN 与冠状动脉造影及 PCI 后死亡率和发病率增加相关，并导致住院费用增加。
考虑了 1218 例患者的几种基线临床特征，这些特征是 CIN 的候选单变量预测因子（造影剂暴露后 5 天内血清肌酐升高>或=0.5mg/dl）。基于多变量逻辑回归的比值比，确定了 7 个标志物（带有权重评分）为 CIN 的独立相关因素：年龄≥73 岁（1）、糖尿病（2）、左心室射血分数 45%或更低（2）、基线血清肌酐值≥1.5mg/dl（2）、基线肌酐清除率 44ml/min 或更低（2）、水化后肌酐值≥水化前肌酐值（2）以及在过去 72h 内进行 1 次手术（3）。
114 例（9.4%）患者发生 CIN[低值（<或=3）和极高值（>或=9）风险评分组分别为 1.1%-52.1%]；CIN 风险随着评分级别的增加而显著增加（Cochran-Armitage 卡方检验，P<0.0001），风险评分可确定术后发生 CIN 的低危和高危患者（C 统计量=0.86）。这些结果在验证组中得到了复制。
术前临床危险因素对 CIN 的发生概率有不同的影响。基于最显著参数的风险分类可用于预测造影剂暴露前的 CIN。这里提出的简单评分系统可以很好地估计 CIN 的风险，使介入团队能够对手术进行适当的调整。
