Analysis Of Risk Factors And Development Of A Novel Risk Score Model For Contrast-induced Nephropathy Undergoing Emergent Percutaneous Coronary Intervention

Objective This study aimed to investigate the risk factors of contrast-induced nephropathy(CIN)in patients who undergwent emergent percuntaneous coronary intervention(PCI),and to develop and validate an easily applicable risk score model for predicting CIN,which help to screen the patients at high risk of CIN and take prophylactic measures early.Further more.we also evaluated the prognosis value of the prediction model.MethodSection 1:Between January 2010 and December 2013,a total of 692 patients undergoing emergent PCI were consecutively enrolled.CIN was define as an increase of absolute serum creatinine(SCr)level by 44.2umol/L(0.5mg/dl)within 72 hours of contrast mediaexposure.Differences in baseline data were compared between CIN group and non-CIN group.The potential risk factors of CIN was identified by using univariate logistic regression analysis,and the independent risk factors was determinate by using multivariate logistic regression analysis.Section 2:692 patients were assigned randomly(2:1)to the development dataset(n = 461)and the validation dataset(n = 231).In the development dataset,The independent risk factors was determinate by using multivariate logistic regression analysis,according to the ? value of multivariate model,every independent risk factor was assigned a weighted integer coefficient value and to establish a simple risk score for the prediction of CIN.The goodness of fit and prognostic accuracy of the model were assessed by using the HosmereLemeshow test and receiver operator characteristic curve.Area under the cure(AUC)was used to compare the predictive value of different models.ResultsSection 1:Overall,the incidence of CIN was 7.9%(55/692).In the univariate logistic regression analysis,the variables included age>75 years,heart rate,hypotension,left ventricular ejection fraction(LVEF)<40%,intra-aortic balloon pump(IABP),SCr>1.5mg/dl,use of diuretics,contrast amount,and hydration volume were significantly associated with CIN.Section 2:In the development dataset,multivariate logistic regression analysis showed that Age>75years,hypotension,use of IABP,SCr>1.5mg/dl were independent predictors of CIN.Every independent predictor was assigned one point and establish a CIN risk score.Patients were stratified into 3 groups according to the risk score,include high-risk group(risk score=0),moderate risk group(risk score ranges from 1 to 2).and low risk group(risk score>2).The Hosmer Lemeshow statistic of the multivariable model demonstrated a good goodness of fit(?2= 2.332,P=0.375>0.05).ROC analysis revealed that the area under curve(AUC)of the predictive of our CIN risk score was 0.828 in validation dataset.Furthermore,compared to the classical Mehran's and ACEF CIN risk score models,the risk score exhibited similar discrimination and predictive ability on CIN(AUC:0.828 vs 0.776;0.828 vs 0.853;all P>0.05).The risk scorealso hadgood predictive ability for in-hospital mortality,2 and 3-years mortality(AUC:0.750,0.732,0.738,respectively)in the validation population.Conclusions The independent risk factors of CIN after emergent PCI were age>75years,LVEF<40%,SCr>1.5mg/dl,hypotension,use of IABP.The risk model was constructed in our study only required four simple clinical variables of age>75years,SCr>1.5mg/dl,hypotension,use of IABP,which exhibited good discrimination and predictive ability on CIN after emergent PCI,and demonstrated high prognostic ability on in-hospital mortality and 2,3-years mortality.