Yin Wenjun, Zhou Ge, Zhou Lingyun, Liu Mancang, Xie Yueliang, Wang Jianglin, Zuo Shanru, Liu Kun, Hu Can, Chen Linhua, Yang Huiqin, Zuo Xiaocong
Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China.
Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China.
BMC Nephrol. 2020 Feb 10;21(1):45. doi: 10.1186/s12882-020-1700-8.
Pre-operative risk scores are more valuable than post-procedure risk scores because of lacking effective treatment for contrast-induced acute kidney injury (CI-AKI). A number of pre-operative risk scores have been developed, but due to lack of effective external validation, most of them are also difficult to apply accurately in clinical practice. It is necessary to review and validate the published pre-operative risk scores for CI-AKI.
We systematically searched PubMed and EMBASE databases for studies of CI-AKI pre-operative risk scores and assessed their calibration and discriminatory in a cohort of 2669 patients undergoing coronary angiography or percutaneous coronary intervention (PCI) from September 2007 to July 2017. The definitions of CI-AKI may affect the validation results, so three definition were included in this study, CI-AKI broad1 was defined as an increase in serum creatinine (Scr) of 44.2 μmol/L or 25%; CI-AKI broad2, an increase in Scr of 44.2 μmol/L or 50%; and CI-AKI-narrow, an increase in Scr of 44.2 μmol/L. The calibration of the model was assessed with the Hosmer-Lemeshow test and the discriminatory capacity was identified by C-statistic.
Of the 8 pre-operative risk scores for CI-AKI identified, 7 were single-center study and only 1 was based on multi-center study. In addition, 7 of the scores were just validated internally and only Chen score was externally validated. In the validation cohort of 2669 patients, the incidence of CI-AKI ranged from 3.0%(Liu) to 16.4%(Chen) for these scores. Furthermore, the incidence of CI-AKI was 6.59% (178) for CI-AKI broad1, 1.44% (39) for CI-AKI broad2, and 0.67% (18) for CI-AKI-narrow. For CI-AKI broads, C-statistics varied from 0.44 to 0.57. For CI-AKI-narrow, the Maioli score had the best discrimination and calibration, what's more, the C-statistics of Maioli, Chen, Liu and Ghani was ≥0.7.
Most pre-operative risk scores were established based on single-center studies and most of them lacked external validation. For CI-AKI broads, the prediction accuracy of all risk scores was low. The Maioli score had the best discrimination and calibration, when using the CI-AKI-narrow definition.
由于缺乏针对造影剂诱导的急性肾损伤（CI-AKI）的有效治疗方法，术前风险评分比术后风险评分更有价值。已经开发了许多术前风险评分，但由于缺乏有效的外部验证，其中大多数也难以在临床实践中准确应用。有必要对已发表的CI-AKI术前风险评分进行回顾和验证。
我们系统检索了PubMed和EMBASE数据库中关于CI-AKI术前风险评分的研究，并在2007年9月至2017年7月期间接受冠状动脉造影或经皮冠状动脉介入治疗（PCI）的2669例患者队列中评估了它们的校准和鉴别能力。CI-AKI的定义可能会影响验证结果，因此本研究纳入了三种定义，CI-AKI broad1定义为血清肌酐（Scr）升高44.2μmol/L或25%；CI-AKI broad2定义为Scr升高44.2μmol/L或50%；CI-AKI-narrow定义为Scr升高44.2μmol/L。使用Hosmer-Lemeshow检验评估模型的校准，并通过C统计量确定鉴别能力。
在确定的8个CI-AKI术前风险评分中，7个是单中心研究，只有1个基于多中心研究。此外，其中7个评分仅在内部进行了验证，只有Chen评分进行了外部验证。在2669例患者的验证队列中，这些评分的CI-AKI发生率从3.0%（Liu）到16.4%（Chen）不等。此外，CI-AKI broad1的CI-AKI发生率为6.59%（178例），CI-AKI broad2为1.44%（39例），CI-AKI-narrow为0.67%（18例）。对于CI-AKI broads，C统计量在0.44至0.57之间变化。对于CI-AKI-narrow，Maioli评分具有最佳的鉴别和校准能力，此外，Maioli、Chen、Liu和Ghani的C统计量≥0.7。
大多数术前风险评分是基于单中心研究建立的，且大多数缺乏外部验证。对于CI-AKI broads，所有风险评分的预测准确性都很低。当使用CI-AKI-narrow定义时，Maioli评分具有最佳的鉴别和校准能力。
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