Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention: From the National Cardiovascular Data Registry.
Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention: From the National Cardiovascular Data Registry.
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DOI：
10.1016/j.jcin.2020.10.028
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发表时间：
2021-02-08
期刊：
影响因子：
--
通讯作者：
Spertus JA
中科院分区：
文献类型：
--
作者：
Safley DM;Salisbury AC;Tsai TT;Secemsky EA;Kennedy KF;Rogers RK;Latif F;Shammas NW;Garcia L;Cavender MA;Rosenfield K;Prasad A;Spertus JA
作者分析了来自NCDR（国家心血管数据登记中心）PVI登记中心的数据，并将急性肾损伤（阿基）定义为肌酐升高≥0.3 mg/dl或50%，或PVI后新的透析要求。AKI是外周血管介入治疗（PVI）的一种重要且可能可改变的并发症。肺静脉隔离术后阿基的发生率、预测因素和结局尚未完全确定。使用与阿基相关的术前特征开发了分层逻辑回归风险模型，随后进行了bootstrap验证。模型创建后，使用提交的数据对模型进行了验证。开发了一个整数评分系统来预测PVI后的AKI。在10，006例手术中，患者的平均年龄为69岁，58%为男性，52%患有糖尿病。737例（7.4%）发生阿基，与院内死亡率增加相关（7.1% vs. 0.7%）。肾小球滤过率降低、高血压、糖尿病、既往心力衰竭、危重或急性肢体缺血和术前血红蛋白与阿基独立相关。预测阿基的模型显示出良好的区分度（乐观校正的c-统计量= 0.68）和校准（校正的斜率= 0.97，截距为-0.07）。整数点系统可以被纳入一个有用的临床工具，因为它区分阿基的风险，评分≤4和≥12分别对应于风险的下限和上限20%。肺静脉隔离术后阿基并不罕见，与院内死亡率相关。NCDR阿基风险模型（包括整数评分系统）可前瞻性估计阿基风险，并有助于部署旨在降低PVI后AKI风险的策略。
The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of −0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI.
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DOI：
10.1093/ndt/gfl213
发表时间：
2006-06-01
期刊：
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
影响因子：
--
作者：
Finn, William F
通讯作者：
Finn, William F
影响因子：
4.3
作者：
Lee, Shin-Rong;Zhuo, Haoran;Chaar, Cassius Iyad Ochoa
通讯作者：
Chaar, Cassius Iyad Ochoa
影响因子：
4.3
作者：
Bodewes, Thomas C. F.;Soden, Peter A.;Schermerhorn, Marc L.
通讯作者：
Schermerhorn, Marc L.
影响因子：
2.3
作者：
Gurm, Hitinder S.;Mavromatis, Kreton;Kumar, Gautam
通讯作者：
Kumar, Gautam
影响因子：
24
作者：
Hess, Connie N.;Rogers, R. Kevin;Hiatt, William R.
通讯作者：
Hiatt, William R.