Risk Factors Of And Risk Score For Prediction Of Contrast Induced Acute Kidney Injury In Elder Patients Underwent Percutaneous Coronary Intervention

Objective:To investigate the risk factors for and develop a simple risk score of contrast induced acute kidney injury (CIAKI) after percutaneous coronary intervention(PCI) in elderly patients.Methods:A retrospective study was performed on668elderly patients for the development dataset, who had underwent PCI from January2010to may2011.277elderly patients who had underwent PCI in the same period were studied for the validation set.Records the patient’s clinical situation and the contrast agent dosage and formulation. According to the diagnostic criteria for CIAKI, the development dataset patients were divided into CIAKI group and non-CIAKI group, related factors were compared between the two groups. Logistic regression analysis was applied to identify risk factors for CIAKI. Based on the odds ratio, and accordance with the rounding principle, the risk factor was given corresponding integer, the sum of the integers was a total risk score for each patient. calculate the incidence of each score,validate the risk score in the validation group.Results:(1) Among the668patients, CIAKI occurred in105patients and the overall incidence of CIAKI was15.7%.In the the validation set, CIAKI occurred in46patients, the incidence of CIAKI was16.1%(2) Nine factors were identified as risk factors of CIAKI (with weighted score):estimated glomerular filtration rate (eGFR)<60ml/min/1.73m2(4), diabetes(3), left ventricular ejection fraction (LVEF)<45%(3), hypotension(2), age>70years(2), myocardial infarction(2), emergency PCI(2), anemia(2), contrast agent volume>200ml (2)(3) The sum of the integers was a total risk score for each patient. The incidence of CIAKI was3.4%in low risk group (≤4),11.9%in the moderate risk group(5-8),36.9%in the high risk group(9-12) and69.8%in the very high risk group(≥13).(4) The model demonstrated good discriminative power in the validation population(c statistic=0.79), showing that the increasing risk score was strongly associated with CIAKI.Conclusion:(1) contrast induced acute kidney injury was a common complication after PCI in elderly patients, more attention should be paid in this complication in clinical.(2)Aged>70years, myocardial infarction, emergency PCI, diabetes mellitus, hypotention, anemia, eGFR<60ml/min, contrast agent volume>200ml, LVEF<45%were risk factors for CIAKI.(3) This simple scoring system provides a good estimate of the risk of CIAKI after PCI in elderly patients and can be used in deciding strategies of prevention and treatment.