Department of Cardiology, 117861Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China.
Angiology. 2023 Apr;74(4):333-343. doi: 10.1177/00033197221105745. Epub 2022 May 31.
Previous studies have demonstrated that non-invasive liver fibrosis scores (LFSs) are associated with kidney function deterioration. This study aimed to assess the predictive performance of LFSs in contrast-associated acute kidney injury (CA-AKI) in coronary artery disease (CAD) patients undergoing elective percutaneous coronary intervention (PCI). This retrospective study involved 5627 patients. The frequency of CA-AKI was 6.3% (n = 353). In a multivariate logistic analysis after adjustment, non-invasive LFSs, including fibrosis-5 score (FIB-5), fibrosis-4 score (FIB-4), aspartate aminotransferase to alanine aminotransferase ratio (AAR), and aspartate aminotransferase to platelet ratio index were independent risk factors for CA-AKI (all < .05), whereas the Forns score was not ( > .05). The highest predictive performance was observed for FIB-5 (area under the curve [AUC] = .644) compared to other LFSs. A restricted cubic spline analysis confirmed approximately linear relationships between LFSs and risks of CA-AKI. Furthermore, adding FIB-5 (AUC = .747; net reclassification improvement [NRI] = .441, < .001; integrated discrimination improvement [IDI] = .008, < .001) or AAR (AUC = .747; NRI = .419, < .001; IDI = .006, = .010) to an established clinical risk model could significantly improve the prediction of CA-AKI. The LFSs were significantly associated with CA-AKI, possibly serving as predictive tools for early identification of CAD patients undergoing elective PCI that are at high risk of CA-AKI.
先前的研究表明,非侵入性肝纤维化评分(LFS)与肾功能恶化有关。本研究旨在评估 LFS 在接受择期经皮冠状动脉介入治疗(PCI)的冠心病(CAD)患者对比相关急性肾损伤(CA-AKI)中的预测性能。这项回顾性研究涉及 5627 名患者。CA-AKI 的发生率为 6.3%(n=353)。在调整后的多变量逻辑分析中,非侵入性 LFS 包括纤维化-5 评分(FIB-5)、纤维化-4 评分(FIB-4)、天冬氨酸氨基转移酶/丙氨酸氨基转移酶比值(AAR)和天冬氨酸氨基转移酶/血小板比值指数都是 CA-AKI 的独立危险因素(均 <.05),而 Forns 评分不是( >.05)。FIB-5 的预测性能最高(曲线下面积[AUC] =.644),优于其他 LFS。限制性三次样条分析证实了 LFS 与 CA-AKI 风险之间存在近似线性关系。此外,添加 FIB-5(AUC =.747;净重新分类改善[NRI] =.441, <.001;综合判别改善[IDI] =.008, <.001)或 AAR(AUC =.747;NRI =.419, <.001;IDI =.006, <.010)到既定的临床风险模型可以显著改善 CA-AKI 的预测。LFS 与 CA-AKI 显著相关,可能作为预测工具,有助于早期识别接受择期 PCI 的 CAD 患者中 CA-AKI 风险较高的患者。