Division of Cardiology, Department of Medicine, University of Verona, Ospedale Civile Maggiore, Verona, Italy.
Am J Med. 2010 Aug;123(8):755-63. doi: 10.1016/j.amjmed.2010.02.026.
The purpose of this study was to evaluate incidence and predictors of contrast-induced nephropathy after coronary angiography and interventions, and to assess renal function at 30 days. The prognostic value of any early shift of serum creatinine compared with baseline was investigated; such measurement, being a delta, is largely independent of creatinine variations.
There were 216 patients at risk for contrast-induced nephropathy prospectively evaluated at baseline and at 12, 24, and 48 hours after exposure to contrast media, and 190 (88%) evaluated 1 month after discharge.
Contrast-induced nephropathy occurred in 39 patients (18%), and 30-day renal damage was detected in 15 (7%). Contrast media/kg volume predicted contrast-induced nephropathy (P=.002), and percentage change of creatinine 12 hours from baseline was significantly higher in patients with nephropathy (P <.001). At multivariate analysis, percentage change of creatinine 12 hour-basal was the best predictor of nephropathy (P <.001). A 5% increase of its value yielded 75% sensitivity and 72% specificity (area under the curve 0.80; odds ratio 7.37; 95% confidence interval, 3.34-16.23) for early contrast-induced nephropathy detection. Furthermore, it strongly correlated with the development of renal impairment at 30 days (P=.002; sensitivity 87%, specificity 70%; area under the curve 0.85; odds ratio 13.29; 95% confidence interval, 2.91-60.64).
Minimal elevations of serum creatinine at 12 hours are highly predictive of contrast-induced nephropathy and 30-day renal damage after exposure to contrast media.
本研究旨在评估冠状动脉造影和介入治疗后对比剂肾病的发生率和预测因素，并评估 30 天的肾功能。研究还评估了与基线相比血清肌酐早期变化的预后价值；这种测量方法是一个差值，在很大程度上独立于肌酐的变化。
前瞻性评估了 216 例有发生对比剂肾病风险的患者，在接触对比剂后分别于基线及 12、24 和 48 小时进行评估，其中 190 例（88%）在出院后 1 个月进行评估。
39 例（18%）患者发生对比剂肾病，15 例（7%）患者出现 30 天肾脏损害。对比剂/kg 体积可预测对比剂肾病（P=0.002），且肾病患者的肌酐 12 小时内的变化率显著高于无肾病患者（P<0.001）。多变量分析显示，肌酐 12 小时-基线变化率是肾病的最佳预测指标（P<0.001）。其值增加 5%，可使肾病的敏感性达到 75%，特异性为 72%（曲线下面积 0.80；优势比 7.37；95%置信区间，3.34-16.23），可早期检测对比剂肾病。此外，它与 30 天肾功能损害的发生密切相关（P=0.002；敏感性 87%，特异性 70%；曲线下面积 0.85；优势比 13.29；95%置信区间，2.91-60.64）。
接触对比剂后 12 小时血清肌酐的轻微升高高度提示对比剂肾病和 30 天肾功能损害。
