Parco Claudio, Brockmeyer Maximilian, Kosejian Lucin, Quade Julia, Tröstler Jennifer, Bader Selina, Lin Yingfeng, Sokolowski Alexander, Hoss Alexander, Heinen Yvonne, Schulze Volker, Icks Andrea, Jung Christian, Kelm Malte, Wolff Georg
Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
Institute for Health Services Research and Health Economics, Medical Faculty and University Hospital, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
J Nephrol. 2021 Oct;34(5):1491-1500. doi: 10.1007/s40620-021-01124-9. Epub 2021 Aug 7.
Contrast-induced nephropathy (CIN) is a major adverse event in patients undergoing coronary angiography. The Mehran risk model is the gold-standard for CIN risk prediction. However, its performance in comparison to more contemporary National Cardiovascular Data Registry-Acute Kidney Injury (NCDR-AKI) risk models remains unknown. We aimed to compare both in this study.
Predictions of Mehran and NCDR-AKI risk models and clinical events of CIN and need for dialysis were assessed in a total of 2067 patients undergoing coronary angiography with or without percutaneous coronary intervention. Risk models were compared regarding discrimination (receiver operating characteristic analysis), net reclassification improvement (NRI) and calibration (graphical and statistical analysis). The NCDR risk model showed superior risk discrimination for predicting CIN (NCDR c-index 0.75, 95% CI 0.72-0.78; vs. Mehran c-index 0.69, 95% CI 0.66-0.72, p < 0.01), and continuous NRI (0.22; 95% CI 0.12-0.32; p < 0.01) compared to the Mehran model. The NCDR risk model tended to underestimate the risk of CIN, while the Mehran model was more evenly calibrated. For the prediction of need for dialysis, NCDR-AKI-D also discriminated risk better (c-index 0.85, 95% CI 0.79-0.91; vs. Mehran c-index 0.75, 95% CI 0.66-0.84; p < 0.01), but continuous NRI showed no benefit and calibration analysis revealed an underestimation of dialysis risk.
In German patients undergoing coronary angiography, the modern NCDR risk model for predicting contrast-induced nephropathy showed superior discrimination compared to the Mehran model while showing less accurate calibration. Results for the outcome 'need for dialysis' were equivocal.
对比剂肾病（CIN）是接受冠状动脉造影患者的主要不良事件。梅兰风险模型是CIN风险预测的金标准。然而，与更现代的国家心血管数据注册中心-急性肾损伤（NCDR-AKI）风险模型相比，其性能仍不清楚。我们旨在本研究中对两者进行比较。
在总共2067例接受或未接受经皮冠状动脉介入治疗的冠状动脉造影患者中，评估了梅兰和NCDR-AKI风险模型的预测以及CIN的临床事件和透析需求。比较了风险模型的辨别力（受试者工作特征分析）、净重新分类改善（NRI）和校准（图形和统计分析）。NCDR风险模型在预测CIN方面显示出更好的风险辨别力（NCDR c指数0.75，95%CI 0.72-0.78；vs.梅兰c指数0.69，95%CI 0.66-0.72，p<0.01），与梅兰模型相比，连续NRI（为0.22；95%CI 0.12-0.32；p<0.01）。NCDR风险模型倾向于低估CIN风险，而梅兰模型校准更为均匀。对于透析需求的预测，NCDR-AKI-D在辨别风险方面也更好（c指数0.85，95%CI 0.79-0.91；vs.梅兰c指数0.75，95%CI 0.66-0.84；p<0.01），但连续NRI未显示出优势，校准分析显示对透析风险的低估。
在接受冠状动脉造影的德国患者中，用于预测对比剂肾病的现代NCDR风险模型与梅兰模型相比显示出更好的辨别力，但校准准确性较低。“透析需求”结果不明确。
