经皮主动脉瓣置换术后对比剂诱导的急性肾损伤预测模型的性能

Performance of Prediction Models for Contrast-Induced Acute Kidney Injury after Transcutaneous Aortic Valve Replacement.

作者信息

Rosa Vitor E E, Campos Carlos M, Bacelar Antonio, Abizaid Alexandre A C, Mangione José A, Lemos Pedro A, Esteves Vinicius, Caramori Paulo, Sampaio Roney O, Tarasoutchi Flávio, Mehran Roxana, Brito Fabio S

机构信息

Hospital Israelita Albert Einstein, São Paulo, Brazil,

Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil,

出版信息

Cardiorenal Med. 2021;11(4):166-173. doi: 10.1159/000517058. Epub 2021 Jul 14.

DOI:10.1159/000517058

PMID:34261063

Abstract

BACKGROUND

Acute kidney injury (AKI) has shown to adversely affect outcomes in patients undergoing transcutaneous aortic valve replacement (TAVR), and its correct risk estimation may interfere in procedural planning and strategies. The aim of the study was to test and compare 6 scores in predicting AKI after TAVR.

METHODS

We tested 6 scores (the contrast material limit score, volume-to-creatinine clearance ratio, ACEF, CR4EATME3AD3, Mehran model A, and Mehran model B) in a total of 559 consecutive patients included in the Brazilian TAVR registry.

RESULTS

All scores had a poor accuracy and calibration to predict the occurrence of AKI grade 1 or 2. All scores improved the accuracy of AKI risk prediction when stratified for AKI grade 2/3 and AKI grade 3 for all scores. The CR4EATME3AD3 was the best predictor of AKI stage 2/3 (AUC: 0.62; OR: 1.12; 95% CI 1.01-1.26; p = 0.04) and AKI stage 3 (AUC: 0.64; OR: 1.16; 95% CI 1.02-1.32; p = 0.02). Mehran models A and B were both good models for AKI stage 3 (AUC: 0.63; OR: 1.10; 95% CI 1.01-1.22; p = 0.05; and AUC: 0.62; OR: 1.10; 95% CI 1.00-1.21; p = 0.05, respectively).

CONCLUSIONS

None of the current models demonstrated validity in detecting AKI when its lower grades were evaluated. CR4EATME3AD3 was the best score in predicting moderate to severe AKI after TAVR. These findings suggest that contrast-induced AKI may not be the only factor related to kidney injury after TAVR.

摘要

背景

急性肾损伤（AKI）已被证明会对接受经皮主动脉瓣置换术（TAVR）的患者的预后产生不利影响，其正确的风险评估可能会影响手术规划和策略。本研究的目的是测试和比较6种预测TAVR术后AKI的评分。

方法

我们在巴西TAVR登记处纳入的559例连续患者中测试了6种评分（造影剂限量评分、容量与肌酐清除率比值、ACEF、CR4EATME3AD3、梅兰模型A和梅兰模型B）。

结果

所有评分在预测1或2级AKI的发生方面准确性和校准性都较差。当对所有评分的2/3级AKI和3级AKI进行分层时，所有评分都提高了AKI风险预测的准确性。CR4EATME3AD3是2/3期AKI（AUC：0.62；OR：1.12；95%CI 1.01-1.26；p = 0.04）和3期AKI（AUC：0.64；OR：1.16；95%CI 1.02-1.32；p = 0.02）的最佳预测指标。梅兰模型A和B都是3期AKI的良好模型（AUC分别为：0.63；OR：1.10；95%CI 1.01-1.22；p = 0.05；和AUC：0.62；OR：1.10；95%CI 1.00-1.21；p = 0.05）。