Volume-to-creatinine clearance ratio - A pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention
Volume-to-creatinine clearance ratio - A pharmacokinetically based risk factor for prediction of early creatinine increase after percutaneous coronary intervention
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DOI：
10.1016/j.jacc.2007.03.058
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发表时间：
2007-08-14
影响因子：
24
通讯作者：
Holmes, David R.
中科院分区：
文献类型：
--
作者：
Laskey, Warren K.;Jenkins, Charles;Holmes, David R.
目的本研究旨在验证经皮冠状动脉介入治疗（PCI）后早期血清肌酐升高风险的药物动力学指标。背景对比剂体积与肌酐清除率的比值（V/CrCl）与对比剂浓度随时间变化的曲线下面积（area under the curve of contrast media concentration over time）相关。在24至48小时内血清肌酐升高> 0.5 mg/dl被认为是异常的。使用受试者-操作者特征方法确定V/CrCl观察范围的最佳灵敏度和特异性。使用多变量logistic regulation.Results的一个异常，早期肌酐增加的总体发病率为1.5%的风险的预测值V/CrCl进行了评估。两组间早期肌酐升高患者（平均值5.2 +/- 4.4，中位数4.3，四分位数范围2.7 - 6.0）和无早期肌酐升高患者（平均值3.0 +/- 2.0，中位数2.5，四分位数范围1.7 - 3.8）的V/CrCl平均值和中位数均存在显著差异（p < 0.001）。此外，V/CrCl与肌酐早期升高之间存在显著相关性（总体和趋势，p < 0.001）。受试者-操作者特征曲线分析表明，V/CrCl比值为3.7是早期肌酐升高的合理范围（C-统计量0.69）。在校正了其他已知的PCI后肌酐升高的预测因素后，V/CrCl >= 3.7仍然与早期血清肌酐异常升高显著相关（优势比3.84; 95%置信区间2.0 - 7.3，P < 0.001）。结论A V/CrCl比值> 3.7是PCI术后早期血清肌酐异常升高的显著独立预测因子。（J Am科尔心脏病学杂志2007;50：584-90）（c）美国心脏病学会基金会2007年。
Objectives This study sought to validate a pharmacokinetically derived measure of the risk of an early increase in serum creatinine after percutaneous coronary intervention (PCl). Background The ratio of the volume of contrast media to the creatinine clearance (V/CrCl) has been shown to correlate with the area under the curve of contrast media concentration over time.Methods We calculated V/CrCl in 3,179 consecutive patients undergoing PCl. An increase in serum creatinine of > 0.5 mg/dl by 24 to 48 h was considered abnormal. Receiver-operator characteristic methods were used to identify the optimal sensitivity and specificity for the observed range of V/CrCl. The predictive value of V/CrCl for the risk of an early increase in creatinine was assessed using multivariable logistic regression.Results The overall incidence of an abnormal, early increase in creatinine was 1.5%. The mean and median values of V/CrCl for patients with (mean 5.2 +/- 4.4, median 4.3, interquartile range 2.7 to 6.0) and without (mean 3.0 +/- 2.0, median 2.5, interquartile range 1.7 to 3.8) an early creatinine increase were each significantly (p < 0.001) different between groups. Furthermore, there was a significant association between V/CrCl and an early increase in creatinine (overall and trend, p < 0.001). The receiver-operator characteristic curve analysis indicated that a V/CrCl ratio of 3.7 was a fair discriminator for the early creatinine increase (C-statistic 0.69). After adjusting for other known predictors of post-PCl creatinine increase, V/CrCl >= 3.7 remained significantly associated with an early abnormal increase in serum creatinine (odds ratio 3.84; 95% confidence interval 2.0 to 7.3, p < 0.001).Conclusions A V/CrCl ratio > 3.7 was a significant and independent predictor of an early abnormal increase in serum creatinine after PCI in this unselected patient population. (J Am Coll Cardiol 2007;50:584-90) (c) 2007 by the American College of Cardiology Foundation.