Risk Factors Of And Risk Score For Prediction Of Contrast Induced Nephropathy In Patients Underwent Percutaneous Coronary Intervention

Objective:To investigate the incidence of and risk factors for contrast induced nephropathy(CIN) after percutaneous coronary intervention(PCI), and develop a simple risk score of CIN after percutaneous coronary intervention(PCI).Methods:A retrospecttive study was performed on1500patients for the development dataset, who had underwent PCI from January2008to May2010. And one thousand patients who had underwent PCI from June2010to december2011were selected for the validation set. Records the patient’s clinical situation and the contrast agent dosage and formulation. According to the diagnostic criteria for CIN, the development dataset patients were divided into CIN group and non-CIN group, related factors were compared between the two groups. Logistic regression analysis was applied to identify risk factors for CIN. 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 the1500patients, CIN occurred in246patients and the overall incidence of CIN was16.4%.In the the validation set, CIN occurred in172patients, the incidence of CIN was17.2%(2)eleven identified variables were identified as risk factors for CIN(with weighted integer):diabetes(3score), hypotension(3score), Left ventricular ejection fraction (LVEF<45%)(3score), eGFR <60ml/min/1.73m2(3score), age>70years(2score), myocardial infarction(2score), emergency PCI(2score), anemia(2score), decreased high-density lipoprotein (HDL) concentration (<1mmol/L)(2score), contrast agent dose of>200ml (2score), low permeability contrast agent (1score).(3) The sum of the integers was a total risk score for each patient. The incidence of CIN was5.2%in low risk group (<4),13.6%in the moderate risk group(5-10),32.3%in the high risk group (11～14) and59.0%in the very high risk group(≥15).(4) The model demonstrated good discriminative power in the validation population, and showed that the increasing risk score was strongly associated with CIN (c-statistic=0.82)Conclusion:(1)Contrast induced nephropathy was a common complication after PCI, 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 CIN.(3)This simple scoring system proposed here provided a good estimate of the risk of CIN after PCI. This risk score can be used for the prevention and treatment of CIN.