A Novel Prediction Model of Acute Kidney Injury Based on Combined Blood Variables in STEMI.
A Novel Prediction Model of Acute Kidney Injury Based on Combined Blood Variables in STEMI.
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DOI：
10.1016/j.jacasi.2021.07.013
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发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Node, Koichi
中科院分区：
文献类型：
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作者：
Goriki, Yuhei;Tanaka, Atsushi;Nishihira, Kensaku;Kuriyama, Nehiro;Shibata, Yoshisato;Node, Koichi
急性肾损伤（阿基）的发生与ST段抬高型心肌梗死（STEMI）患者的不良预后相关。本研究旨在研究术前血液检查的组合是否可以预测STEMI患者的阿基发生率。共招募了908例在症状发作48小时内接受直接经皮冠状动脉介入治疗的连续日本STEMI患者，并将其分为推导（n = 617）和验证（n = 291）队列。基于入院时常规血液检查评估的参数组合创建风险评分模型。在推导队列中，多变量分析显示以下4个变量与阿基显著相关：血糖≥200 mg/dL（比值比[OR]：2.07），高敏肌钙蛋白I >1.6 ng/mL（正常值上限×50）（OR：2.43），白蛋白≤3.5 mg/dL（OR：2.85），估计肾小球滤过率<45 mL/min/1.73 m2（OR：2.64）。根据这些因素的数量给予0到4分。在两个队列中，增量风险评分与阿基的较高发生率显著相关（P < 0.001）。风险模型的受试者工作特征曲线分析显示，AKI患者和非阿基患者之间有充分的区分（推导队列，曲线下面积：0.754; 95%置信区间：0.733-0.846;验证队列，曲线下面积：0.754; 95%置信区间：0.644-0.839）。我们新的基于实验室的模型可能有助于STEMI患者术后阿基风险的早期预测。
Development of acute kidney injury (AKI) is associated with poor prognosis in patients with ST-segment elevation myocardial infarction (STEMI). This study sought to investigate whether a combination of pre-procedural blood tests could predict the incidence of AKI in patients with STEMI. A total of 908 consecutive Japanese patients with STEMI who underwent primary percutaneous coronary intervention within 48 hours of symptom onset were recruited and divided into derivation (n = 617) and validation (n = 291) cohorts. A risk score model was created based on a combination of parameters assessed on routine blood tests on admission. In the derivation cohort, multivariate analysis showed that the following 4 variables were significantly associated with AKI: blood sugar ≥200 mg/dL (odds ratio [OR]: 2.07), high-sensitivity troponin I >1.6 ng/mL (upper limit of normal ×50) (OR: 2.43), albumin ≤3.5 mg/dL (OR: 2.85), and estimated glomerular filtration rate <45 mL/min/1.73 m2 (OR: 2.64). Zero to 4 points were given according to the number of those factors. Incremental risk scores were significantly associated with a higher incidence of AKI in both cohorts (P < 0.001). Receiver-operating characteristic curve analysis of risk models showed adequate discrimination between patients with and without AKI (derivation cohort, area under the curve: 0.754; 95% confidence interval: 0.733-0.846; validation cohort, area under the curve: 0.754; 95% confidence interval: 0.644-0.839). Our novel laboratory-based model might be useful for early prediction of the post-procedural risk of AKI in patients with STEMI.