Araujo Gustavo N, Wainstein Marco V, McCabe James M, Huang Pei-Hsiu, Govindarajulu Usha S, Resnic Frederic S
Hospital de Clinicas de Porto Alegre and Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
University of Washington, Seattle, Washington.
J Interv Cardiol. 2016 Oct;29(5):447-453. doi: 10.1111/joic.12315. Epub 2016 Jul 4.
We sought to compare 2 contrast-induced nephropathy (CIN) risk prediction models in a validation cohort using a consensus definition.
Contrast-induced nephropathy (CIN) is independently associated with mortality following percutaneous coronary intervention (PCI). Multiple prediction models for the development of CIN have been published using heterogeneous outcome definitions.
We analyzed 5,540 patients who underwent PCI from January 2005 to June 2012 at a single academic medical center. The primary outcome was development of CIN, defined as an increase in serum creatinine of ≥0.5 mg/dl or a relative increase of ≥25% from baseline. Receiver operator characteristic (ROC) curves were used to evaluate the discriminatory power of Mehran and WBH prediction models.
The mean age of our cohort was 68 ± 12 years. The mean baseline creatinine was 1.2 ± 0.53 mg/dl (eGFR 73 ± 27 ml/min). The mean contrast volume used was 212 ± 92 ml. CIN occurred in 436 patients (7.9%). The Mehran risk score demonstrated better discrimination than the William Beaumont Hospital (WBH) risk score to predict the occurrence of CIN (c statistic: 0.82 vs. 0.73, respectively). Mortality at 30 days was approximately 8 times higher among patients with CIN as compared to those without (14.7% vs. 1.8% P < 0.01).
In an independent validation cohort, the Mehran risk model demonstrates greater discriminatory power than the WBH model in predicting the incidence of CIN. Mortality was significantly higher in patients who developed CIN after PCI.
我们试图在一个验证队列中使用共识定义比较两种对比剂诱导的肾病（CIN）风险预测模型。
对比剂诱导的肾病（CIN）与经皮冠状动脉介入治疗（PCI）后的死亡率独立相关。已经发表了多种使用异质性结局定义的CIN发生预测模型。
我们分析了2005年1月至2012年6月在一家学术医疗中心接受PCI的5540例患者。主要结局是CIN的发生，定义为血清肌酐升高≥0.5mg/dl或较基线相对升高≥25%。采用受试者操作特征（ROC）曲线评估Mehran和WBH预测模型的辨别力。
我们队列的平均年龄为68±12岁。平均基线肌酐为1.2±0.53mg/dl（估算肾小球滤过率73±27ml/min）。使用的平均对比剂体积为212±92ml。436例患者（7.9%）发生了CIN。在预测CIN的发生方面，Mehran风险评分比威廉博蒙特医院（WBH）风险评分表现出更好的辨别力（c统计量分别为0.82和0.73）。与未发生CIN的患者相比，发生CIN的患者30天死亡率大约高8倍（14.7%对1.8%，P<0.01）。
在一个独立的验证队列中，Mehran风险模型在预测CIN发生率方面比WBH模型具有更大的辨别力。PCI后发生CIN的患者死亡率显著更高。
