GRACE风险评分对接受直接经皮冠状动脉介入治疗前的ST段抬高型心肌梗死患者造影剂诱导的急性肾损伤的预测价值。
Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention.
作者信息
Liu Yuan Hui, Liu Yong, Tan Ning, Chen Ji-Yan, Chen Jin, Chen Shao-Hui, He Yi-Ting, Ran Peng, Ye Piao, Li Yun
机构信息
Department of Cardiology, Guangdong General Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
出版信息
Int Urol Nephrol. 2014 Feb;46(2):417-26. doi: 10.1007/s11255-013-0598-5. Epub 2013 Nov 22.
OBJECTIVES
Contrast-induced acute kidney injury (CI-AKI) is a well-known serious complication of percutaneous coronary intervention (PCI) and may cause increased morbidity and mortality. We aim to identify the predictive value of Global Registry for Acute Coronary Events (GRACE) risk scores for CI-AKI in patients with ST-segment elevation myocardial infarction (STEMI) before primary PCI, allowing pre-procedural decisions regarding prevention therapy for CI-AKI.
METHODS
We enrolled 251 consecutive patients with STEMI undergoing primary PCI. Receiver operating characteristic curves were used to identify the optimal sensitivity for the observed range of GRACE risk scores. CI-AKI was defined as any of the following: absolute increase in serum creatinine (SCr) of ≥ 0.3 or ≥ 0.5 mg/dL within 48-72 h after contrast exposure, or a percentage increase in SCr level of ≥ 50 %.
RESULTS
Forty-three patients (17.1 %) developed CI-AKI0.3, 22 (8.8 %) CI-AKI0.5, and 19 (7.6 %) CI-AKI50. The GRACE quartiles were as follows: Q1 (<136), Q2 (136-159), Q3 (159-180), and Q4 (>180). Patients with high GRACE risk scores had higher risk for CI-AKI0.3, 0.5, and 50 (6.6, 6.6, 23.4, 31.7 %, respectively, p < 0.001; 1.6, 1.6, 9.4, 22.2 %, respectively, p < 0.001; and 3.3, 3.2, 9.4, 14.3 %, respectively, p = 0.009). ROC showed that a GRACE risk score >160 was a fair discriminator for CI-AKI0.3, 0.5, and 50 (C statistic = 0.723, 0.788, 0.668, respectively). After adjusting for potential confounding predictors, GRACE risk score >160 remained significantly associated with CI-AKI0.3 or 0.5 (OR 3.84; 95 % CI 1.61-9.17; p = 0.002, or OR 5.54; 95 % CI 1.42-21.66; p = 0.014), and high-sensitivity C-reactive protein (Hs-CRP) >15.5 mg/L was a highly significant predictor of CI-AKI0.3, 0.5, and CI-AKI50.
CONCLUSIONS
GRACE risk score (>160) and post-procedural Hs-CRP >15.5 mg/L are independent and significant predictors of CI-AKI in patients with STEMI before primary PCI.
目的
造影剂诱发的急性肾损伤（CI-AKI）是经皮冠状动脉介入治疗（PCI）一种众所周知的严重并发症，可能导致发病率和死亡率增加。我们旨在确定全球急性冠状动脉事件注册研究（GRACE）风险评分对ST段抬高型心肌梗死（STEMI）患者在直接PCI前发生CI-AKI的预测价值，以便在PCI术前就CI-AKI的预防治疗做出决策。
方法
我们连续纳入了251例接受直接PCI的STEMI患者。采用受试者工作特征曲线来确定GRACE风险评分观察范围内的最佳敏感度。CI-AKI定义为以下任何一种情况：造影剂暴露后48 - 72小时内血清肌酐（SCr）绝对值增加≥0.3或≥0.5 mg/dL，或SCr水平百分比增加≥50%。
结果
43例患者（17.1%）发生CI-AKI0.3，22例（8.8%）发生CI-AKI0.5，19例（7.6%）发生CI-AKI50。GRACE四分位数如下：Q1（<136），Q2（136 - 159），Q3（159 - 180），Q4（>180）。GRACE风险评分高的患者发生CI-AKI0.3、0.5和50的风险更高（分别为6.6%、6.6%、23.4%、31.7%，p < 0.001；分别为1.6%、1.6%、9.4%、22.2%，p < 0.001；分别为3.3%、3.2%、9.4%、14.3%，p = 0.009）。ROC曲线显示，GRACE风险评分>160对CI-AKI0.3、0.5和50是一个较好的鉴别指标（C统计量分别为0.723、0.788、0.668）。在调整潜在的混杂预测因素后，GRACE风险评分>160仍与CI-AKI0.3或0.5显著相关（OR 3.84；95%CI 1.61 - 9.17；p = 0.002，或OR 5.54；95%CI 1.42 - 21.66；p = 0.014），且高敏C反应蛋白（Hs-CRP）>15.5 mg/L是CI-AKI0.3、0.5和CI-AKI50的高度显著预测指标。
结论
GRACE风险评分（>160）和术后Hs-CRP>15.5 mg/L是STEMI患者直接PCI前发生CI-AKI的独立且显著的预测指标。
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