The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
BMC Cardiovasc Disord. 2020 Aug 31;20(1):399. doi: 10.1186/s12872-020-01689-6.
Risk stratification is recommended as the key step to prevent contrast-associated acute kidney injury (CA-AKI) among at-risk patients following coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Patients with hypoalbuminemia are prone to CA-AKI and do not have their own risk stratification tool. Therefore, this study developed and validated a new model for predicting CA-AKI among hypoalbuminemia patients CAG/PCI.
1272 patients with hypoalbuminemia receiving CAG/PCI were enrolled and randomly allocated (2:1 ratio) into the development cohort (n = 848) and the validation cohort (n = 424). CA-AKI was defined as an increase of ≥0.3 mg/dL or 50% in serum creatinine (SCr) compared to baseline in the 48 to 72 h after CAG/PCI. A prediction model was established with independent predictors according to stepwise logistic regression, showing as a nomogram. The discrimination of the new model was evaluated by the area under the curve (AUC) and was compared to the classic Mehran CA-AKI model. The Hosmer-Lemeshow test was conducted to assess the calibration of our model.
Overall, 8.4% (71/848) patients of the development group and 11.2% (48/424) patients of the validation group experienced CA-AKI. A new nomogram included estimated glomerular filtration rate (eGFR), serum albumin (ALB), age and the use of intra-aortic balloon pump (IABP); showed better predictive ability than the Mehran score (C-index 0.756 vs. 0.693, p = 0.02); and had good calibration (Hosmer-Lemeshow test p = 0.187).
We developed a simple model for predicting CA-AKI among patients with hypoalbuminemia undergoing CAG/PCI, but our findings need validating externally.
http://www.ClinicalTrials.gov NCT01400295 , retrospectively registered 21 July 2011.
风险分层被推荐作为预防接受冠状动脉造影（CAG）和/或经皮冠状动脉介入治疗（PCI）的高危患者发生造影剂相关急性肾损伤（CA-AKI）的关键步骤。低白蛋白血症患者易发生 CA-AKI，但目前尚无针对该人群的风险分层工具。因此，本研究开发并验证了一种新的模型，用于预测 CAG/PCI 后低白蛋白血症患者的 CA-AKI。
纳入了 1272 例接受 CAG/PCI 的低白蛋白血症患者，并按 2:1 的比例随机分配到开发队列（n=848）和验证队列（n=424）。CA-AKI 定义为 CAG/PCI 后 48 至 72 小时内，血清肌酐（SCr）较基线升高≥0.3mg/dL 或 50%。根据逐步逻辑回归，采用独立预测因子建立预测模型，表现为诺模图。通过曲线下面积（AUC）评估新模型的区分度，并与经典的 Mehran CA-AKI 模型进行比较。采用 Hosmer-Lemeshow 检验评估模型的校准度。
总体而言，开发组中有 8.4%（71/848）的患者和验证组中有 11.2%（48/424）的患者发生 CA-AKI。一个新的诺模图包括估计肾小球滤过率（eGFR）、血清白蛋白（ALB）、年龄和主动脉内球囊泵（IABP）的使用；与 Mehran 评分相比，具有更好的预测能力（C 指数 0.756 与 0.693，p=0.02）；且具有良好的校准度（Hosmer-Lemeshow 检验，p=0.187）。
我们开发了一种用于预测接受 CAG/PCI 的低白蛋白血症患者发生 CA-AKI 的简单模型，但我们的研究结果需要进一步验证。
http://www.ClinicalTrials.gov，NCT01400295，于 2011 年 7 月 21 日进行了回顾性注册。
