A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

Abstract

Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

Preventive Effect of Shenduning Prescription Combined with Hydration Therapy on Contrast Induced Nephronpathy after Elective Percutaneous Coronary Intervention

“…5ml of peripheral venous blood was collected from all subjects on the morning after admission, 24h and 72h after operation, respectively, and CIN was calculated according to the postoperative Scr peak of patients. The diagnostic criteria for CIN [7] : serum Scr value increased ≥0.5mg/dl (44.2μmol/L) in contrast with baseline absolute value or relative value increased≥25% within 72h after exposure to iodine contrast agent, excluding renal function impairment caused by other reasons. Main observation indexes: (1) Kidney injury markers include serum creatinine (Scr) and glomerular filtration rate (eGFR).…”