Development and Validation of a Model for Predicting the Risk of Acute Kidney Injury Associated With Contrast Volume Levels During Percutaneous Coronary Intervention.
JAMA Netw Open
; 2(11): e1916021, 2019 11 01.
Article
in En
| MEDLINE
| ID: mdl-31755952
ABSTRACT
Importance Determining the association of contrast volume during percutaneous coronary intervention (PCI) with the risk of acute kidney injury (AKI) is important for optimizing PCI safety. Objective:
To quantify how the risk of AKI is associated with contrast volume, accounting for the possibility of nonlinearity and heterogeneity among different baseline risks. Design, Setting, andParticipants:
This prognostic study used data from the American College of Cardiology National Cardiovascular Data Registry CathPCI Registry for 1694 US hospitals. Derivation analysis included 2â¯076â¯694 individuals who underwent PCI from July 1, 2011, to June 30, 2015. Validation analysis included 961â¯863 individuals who underwent PCI from July 1, 2015, to March 31, 2017. Data analysis took place from July 2018 to May 2019. Exposure Contrast volume during PCI. Main Outcomes andMeasures:
Acute kidney injury was defined using 3 thresholds for preprocedure to postprocedure creatinine level increase (ie, ≥0.3 mg/dL, ≥0.5 mg/dL, and ≥1.0 mg/dL). A model quantifying the association of contrast volume with AKI was developed, and the existence of nonlinearity and heterogeneity were examined by likelihood ratio tests. The model was derived in the training set (a random 50% of the derivation cohort), and performance was evaluated in the test set (the remaining 50% of the derivation cohort) and an independent validation set by area under the receiver operating characteristic curve (AUC) and calibration slope of observed vs predicted risks.Results:
The 2â¯076â¯694 patients in the derivation set had a mean (SD) age of 65.1 (12.1) years, and 662â¯525 (31.9%) were women; 133â¯306 (6.4%) had creatinine level increases of at least 0.3 mg/dL, 66â¯626 (3.2%) had creatinine level increases of at least 0.5 mg/dL, and 28â¯378 (1.4%) had creatinine level increases of at least 1.0 mg/dL. In the validation set of 961â¯843 patients (mean [SD] age, 65.7 [12.1] years; 305â¯577 [31.8%] women), these rates were 62â¯913 (6.5%), 34â¯229 (3.6%), and 15â¯555 (1.6%), respectively. The association of contrast volume and AKI risk was nonlinear (χ226 = 1436.2; P < .001) and varied by preprocedural risk (χ220 = 105.6; P < .001). In the test set, the model yielded an AUC of 0.777 (95% CI, 0.775-0.779) for predicting risk of a creatinine level increase of at least 0.3 mg/dL, 0.839 (95% CI, 0.837-0.841) for predicting risk of a creatinine level increase of at least 0.5 mg/dL, and 0.870 (95% CI, 0.867-0.873) for predicting risk of a creatinine level increase of at least 1.0 mg/dL; it achieved a calibration slope of 0.998 (95% CI, 0.989-1.007), 0.999 (95% CI, 0.989-1.008), and 0.986 (95% CI, 0.973-0.998), respectively, for the AKI severity levels. The model had similar performance in the validation set (creatinine level increase of ≥0.3 mg/dL AUC, 0.794; 95% CI, 0.792-0.795; calibration slope, 1.039; 95% CI, 1.030-1.047; creatinine level increase of ≥0.5 mg/dL AUC, 0.845; 95% CI, 0.843-0.848; calibration slope, 1.063; 95% CI, 1.054-1.074; creatinine level increase of ≥1.0 mg/dL AUC, 0.872; 95% CI, 0.869-0.875; calibration slope, 1.103; 95% CI, 1.089-1.117). Conclusions and Relevance The association of contrast volume with AKI risk is complex, varies by baseline risk, and can be predicted by a model. Future research to evaluate the effect of the model on AKI is needed.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Risk Assessment
/
Contrast Media
/
Acute Kidney Injury
/
Percutaneous Coronary Intervention
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
Language:
En
Journal:
JAMA Netw Open
Year:
2019
Document type:
Article