Refining Safe Contrast Limits for Preventing Acute Kidney Injury After Percutaneous Coronary Intervention.
Refining Safe Contrast Limits for Preventing Acute Kidney Injury After Percutaneous Coronary Intervention.
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DOI：
10.1161/jaha.120.018890
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发表时间：
2021-01-05
影响因子：
5.4
通讯作者：
Ebinger JE
中科院分区：
文献类型：
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作者：
Yuan N;Latif K;Botting PG;Elad Y;Bradley SM;Nuckols TK;Cheng S;Ebinger JE
造影剂相关急性肾损伤 (CA-AKI) 与较高的发病率相关，在经皮冠状动脉介入治疗 (PCI) 期间使用较少的造影剂可以预防造影剂相关急性肾损伤 (CA-AKI)。然而，用于确定安全造影剂体积的工具是有限的。我们开发了风险模型来定制 PCI 期间的安全造影剂体积限制。利用 2015 年 1 月至 2018 年 3 月在 18 家医院进行的所有 PCI 的数据，我们开发了用于预测 CA-AKI 的逻辑回归模型，包括更简单的模型（“实用完整”、“实用最小”），仅使用从电子健康记录中轻松推导出来的预测变量。我们使用 2018 年 4 月至 2018 年 12 月的 PCI 数据前瞻性地验证了这些模型，并使用受试者工作特征曲线 (AUC) 下的面积将它们与预先存在的安全对比模型进行比较。模型推导数据集包括 20579 个 PCI 和 2102 个 CA-AKI 病例。当将模型应用于单独的验证数据集（5423 个 PCI、488 个 CA-AKI 病例）时，先前的安全对比限值（5*体重/肌酐、2*肌酐清除率）是较差的安全措施，预测 CA-AKI 的准确度分别为 53.7% 和 56.6%。完整模型、实用完整模型和实用最小模型的表现明显更好（准确度分别为 73.1%、69.3%、66.6%；AUC 为 0.80、0.76、0.72，而 5 * 体重/肌酐为 0.59，2* 肌酐清除率为 0.61）。我们发现，应用安全对比限度可以有效降低四分之一患者的 CA-AKI 风险。与预先存在的方程相比，新的安全对比度限制多变量模型在预测 CA-AKI 方面要准确得多，并且可以帮助确定哪些患者在 PCI 期间从限制对比度中受益最多。利用现成的电子健康记录数据，这些模型可以应用到电子健康记录中，为提高 PCI 安全性提供可操作的信息。
Contrast‐associated acute kidney injury (CA‐AKI) is associated with substantial morbidity and may be prevented by using less contrast during percutaneous coronary intervention (PCI). However, tools for determining safe contrast volumes are limited. We developed risk models to tailor safe contrast volume limits during PCI. Using data from all PCIs performed at 18 hospitals from January 2015 to March 2018, we developed logistic regression models for predicting CA‐AKI, including simpler models (“pragmatic full,” “pragmatic minimum”) using only predictors easily derivable from electronic health records. We prospectively validated these models using PCI data from April 2018 to December 2018 and compared them to preexisting safe contrast models using the area under the receiver operating characteristic curve (AUC). The model derivation data set included 20 579 PCIs with 2102 CA‐AKI cases. When applying models to the separate validation data set (5423 PCIs, 488 CA‐AKI cases), prior safe contrast limits (5*Weight/Creatinine, 2*CreatinineClearance) were poor measures of safety with accuracies of 53.7% and 56.6% in predicting CA‐AKI, respectively. The full, pragmatic full, and pragmatic minimum models performed significantly better (accuracy, 73.1%, 69.3%, 66.6%; AUC, 0.80, 0.76, 0.72 versus 0.59 for 5 * Weight/Creatinine, 0.61 for 2*CreatinineClearance). We found that applying safe contrast limits could meaningfully reduce CA‐AKI risk in one‐quarter of patients. Compared with preexisting equations, new multivariate models for safe contrast limits were substantially more accurate in predicting CA‐AKI and could help determine which patients benefit most from limiting contrast during PCI. Using readily available electronic health record data, these models could be implemented into electronic health records to provide actionable information for improving PCI safety.