Victor Suma M, Gnanaraj Anand, S VijayaKumar, Deshmukh Rajendra, Kandasamy Mani, Janakiraman Ezhilan, Pandurangi Ulhas M, Latchumanadhas K, Abraham Georgi, Mullasari Ajit S
Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
Indian Heart J. 2014 Sep-Oct;66(5):517-24. doi: 10.1016/j.ihj.2014.05.025. Epub 2014 Jun 10.
Contrast induced nephropathy (CIN) is associated with significant morbidity and mortality after percutaneous coronary intervention (PCI). The aim of this study is to evaluate the collective probability of CIN in Indian population by developing a scoring system of several identified risk factors in patients undergoing PCI.
This is a prospective single center study of 1200 consecutive patients who underwent PCI from 2008 to 2011. Patients were randomized in 3:1 ratio into development (n = 900) and validation (n = 300) groups. CIN was defined as an increase of ≥25% and/or ≥0.5 mg/dl in serum creatinine at 48 hours after PCI when compared to baseline value. Seven independent predictors of CIN were identified using logistic regression analysis - amount of contrast, diabetes with microangiopathy, hypotension, peripheral vascular disease, albuminuria, glomerular filtration rate (GFR) and anemia. A formula was then developed to identify the probability of CIN using the logistic regression equation.
The mean (±SD) age was 57.3 (±10.2) years. 83.6% were males. The total incidence of CIN was 9.7% in the development group. The total risk of renal replacement therapy in the study group is 1.1%. Mortality is 0.5%. The risk scoring model correlated well in the validation group (incidence of CIN was 8.7%, sensitivity 92.3%, specificity 82.1%, c statistic 0.95).
A simple risk scoring equation can be employed to predict the probability of CIN following PCI, applying it to each individual. More vigilant preventive measures can be applied to the high risk candidates.
造影剂肾病（CIN）与经皮冠状动脉介入治疗（PCI）后的严重发病率和死亡率相关。本研究的目的是通过建立一个针对接受PCI患者的若干已确定危险因素的评分系统，来评估印度人群中CIN的总体概率。
这是一项对2008年至2011年连续1200例接受PCI患者的前瞻性单中心研究。患者按3:1的比例随机分为开发组（n = 900）和验证组（n = 300）。CIN定义为PCI术后48小时血清肌酐较基线值升高≥25%和/或≥0.5mg/dl。使用逻辑回归分析确定了CIN的七个独立预测因素——造影剂用量、伴有微血管病变的糖尿病、低血压、外周血管疾病、蛋白尿、肾小球滤过率（GFR）和贫血。然后使用逻辑回归方程建立了一个公式来确定CIN的概率。
平均（±标准差）年龄为57.3（±10.2）岁。男性占83.6%。开发组中CIN的总发生率为9.7%。研究组中肾脏替代治疗的总风险为1.1%。死亡率为0.5%。风险评分模型在验证组中相关性良好（CIN发生率为8.7%，敏感性为92.3%，特异性为82.1%，c统计量为0.95）。
可以采用一个简单的风险评分方程来预测PCI后CIN的概率，并将其应用于每个个体。可以对高危患者采取更严格的预防措施。
