Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004.
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China 221004.
Cardiovasc Ther. 2022 Oct 27;2022:5443880. doi: 10.1155/2022/5443880. eCollection 2022.
The aim of the study was to investigate the factors influencing contrast-induced acute kidney injury (CI-AKI) after percutaneous intervention (PCI) in patients with acute coronary syndrome (ACS) with diabetes mellitus (DM). A total of 1073 patients with ACS combined with DM who underwent PCI at the Affiliated Hospital of Xuzhou Medical University were included in this study. We divided the patients into the CI-AKI and non-CI-AKI groups according to whether CI-AKI occurred or not. The patients were then randomly assigned to the training and validation sets at a proportion of 7 : 3. Based on the results of the LASSO regression and multivariate analyses, we determined that the subtypes of ACS, age, multivessel coronary artery disease, hyperuricemia, low-density lipoprotein cholesterol, triglyceride-glucose index, and estimated glomerular filtration rate were independent predictors on CI-AKI after PCI in patients with ACS combined with DM. Using the above indicators to develop the nomogram, the AUC-ROC of the training and validation sets were calculated to be 0.811 (95% confidence interval (CI): 0.766-0.844) and 0.773 (95% CI: 0.712-0.829), respectively, indicating high prediction efficiency. After verification by the Bootstrap internal verification, we found that the calibration curves showed good agreement between the nomogram predicted and observed values. And the DCA results showed that the nomogram had a high clinical application. In conclusion, we constructed and validated the nomogram to predict CI-AKI risk after PCI in patients with ACS and DM. The model can provide a scientific reference for predicting the occurrence of CI-AKI and improving the prognosis of patients.
本研究旨在探讨合并糖尿病的急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)后发生对比剂诱导的急性肾损伤(CI-AKI)的影响因素。共纳入 1073 例在徐州医科大学附属医院接受 PCI 治疗的合并糖尿病的 ACS 患者。根据是否发生 CI-AKI,将患者分为 CI-AKI 组和非 CI-AKI 组。然后,将患者按 7:3 的比例随机分配到训练集和验证集。基于 LASSO 回归和多因素分析的结果,我们确定 ACS 亚型、年龄、多支冠状动脉疾病、高尿酸血症、低密度脂蛋白胆固醇、甘油三酯-葡萄糖指数和估算肾小球滤过率是合并糖尿病的 ACS 患者 PCI 后发生 CI-AKI 的独立预测因子。使用上述指标建立列线图,计算训练集和验证集的 AUC-ROC 分别为 0.811(95%置信区间(CI):0.766-0.844)和 0.773(95%CI:0.712-0.829),表明预测效率较高。通过 Bootstrap 内部验证验证后,我们发现校准曲线显示列线图预测值与观察值之间具有良好的一致性。并且 DCA 结果表明该列线图具有较高的临床应用价值。总之,我们构建并验证了预测合并糖尿病的 ACS 患者 PCI 后发生 CI-AKI 风险的列线图。该模型可以为预测 CI-AKI 的发生和改善患者预后提供科学参考。