Lei Li, He Yibo, Guo Zhaodong, Liu Bowen, Liu Jin, Nie Zhiqiang, Chen Guanzhong, Liu Liwei, Lin Mengfei, Yan Wenhe, Chen Shiqun, Jiyan Chen, Liu Yong
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Affiliated with South China University of Technology, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Cardiol Res Pract. 2021 Mar 23;2021:9614953. doi: 10.1155/2021/9614953. eCollection 2021.
Patients with congestive heart failure (CHF) are vulnerable to contrast-induced kidney injury (CI-AKI), but few prediction models are currently available. Therefore, we aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography.
A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48-72 hours following the procedure. Predictors for the simple nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer-Lemeshow test and 1000 bootstrap samples.
The incidence of CI-AKI was 9.06% (170) in the total sample, 8.64% ( = 109) in the development cohort, and 9.92% ( = 61) in the validation cohort (=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction, and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs. 0.75, =0.061), as well as a well-fitted calibration curve.
The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed.
充血性心力衰竭（CHF）患者易发生造影剂诱导的肾损伤（CI-AKI），但目前可用的预测模型较少。因此，我们旨在为接受冠状动脉造影的CHF患者建立一个简单的列线图，用于CI-AKI风险评估。
共纳入1876例连续的CHF患者（定义为纽约心脏协会功能分级II-IV级或Killip分级II-IV级），并随机（2:1）分配至开发队列和验证队列。终点为CI-AKI，定义为术后48-72小时内血清肌酐升高≥0.3mg/dL或较基线升高50%。通过多变量逻辑回归逐步选择简单列线图的预测因子。使用受试者操作特征（ROC）曲线下面积评估判别能力，并在验证队列中与经典的Mehran评分进行比较。使用Hosmer-Lemeshow检验和1000次自抽样评估校准情况。
总样本中CI-AKI的发生率为9.06%（170例），开发队列中为8.64%（n = 109例），验证队列中为9.92%（n = 61例）（P = 0.367）。包含四个预测因子（年龄、主动脉内球囊反搏、急性心肌梗死和慢性肾脏病）的简单列线图显示出与Mehran评分相似的预测能力（曲线下面积：0.80对0.75，P = 0.061），以及拟合良好的校准曲线。
目前这个包含四个预测因子的简单列线图是识别有CI-AKI风险的CHF患者的简单可靠工具，不过还需要进一步的外部验证。
