Risk Score for the Prediction of Contrast-Induced Nephropathy in Elderly Patients Undergoing Percutaneous Coronary Intervention

Abstract

We developed a risk score for contrast-induced nephropathy (CIN) in elderly patients (n = 668) before percutaneous coronary intervention (PCI). Another 277 elderly patients were studied for validation. Based on the odds ratio, risk factors were assigned a weighted integer; the sum of the integers was the risk score. Among the 668 elderly patients, 105 (15.7%) experienced CIN. There were 9 risk factors for CIN (with weighted integer): estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) (4), diabetes (3), left ventricular ejection fraction <45% (3), hypotension (2), age >70 years (2), myocardial infarction (2), emergency PCI (2), anemia (2), and contrast agent volume >200 mL (2). The incidence of CIN was 3.4%, 11.9%, 36.9%, and 69.8% in the low-risk (≤4), moderate risk (5-8), high-risk (9-12), and very-high-risk groups (≥13). The model demonstrated good discriminative power in the validation population (c statistic = 0.79). This score can be used to plan preventative measures.

The Role of Serum Cystatin C in the Early Detection of Contrast-Induced Nephropathy after Coronary Intervention

“…The results of the present study are in agreement with the most results obtained by others reports Kato et al and Mehran et al [19][20][21][22][23][24][25][26][27]. In present study was found a highly significant increment in serum creatinine and cystatin C while decrease in eGFR 24 hours after angiography (p<0.001, 0.01) when compared between two groups (CIN+, CIN-).…”

“…In present study was found a highly significant increment in serum creatinine and cystatin C while decrease in eGFR 24 hours after angiography (p<0.001, 0.01) when compared between two groups (CIN+, CIN-). This result is consistent with Wang et al, Liu et al and Nozue et al founded serum level of cystatin C is a reliable marker for CIN at 24 hours p<0.001 and serum creatinine increased significantly at 48 hours, also study carried by Wacker-Gussmann et al [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] found that cystatin C level and the cystatin C/creatinine ratio independently predict the risk of CIN in patients undergoing coronary angiography, but another study by Ribichini et al [32] found a significant increase in serum cystatin C concentrations 12 hours earlier than serum creatinine, therefore a rise of serum cystatin C at 12 hours from baseline was the earliest predictor of CIN than serum creatinine [18].…”

“…This may be explained by a larger amount of contrast media we used in PCI group [22]. Therefore contrast volume >100 ml may be identified as a risk factor of occurrence CIN [23,24]. Although all patients involved in our study were given low-osmolar contrast agent Omnipaque (Iohexol) 350 mg/1 ml), osmality of 844.…”

“…Although several studies have revealed that serum cystatin C cut off level >1.2 or >1.18 or >1.3 mg/l, 94% sensitivity and 48% specificity is more accurate for diagnostic CIN than serum creatinine [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36]. While study obtained by Ribichini et al found that absolute changes in serum creatinine proved more accurate than serum cystatin C for predicting CIN at an early stage 12 hours after angiography [18].…”

Contrast-induced nephropathy after primary angioplasty for acute myocardial infarction

“…Apesar da alta incidência de NIC, como ocorre nesse tipo de amostra (cateterismo urgente por IAM), podemos identificar características "protetoras" da amostra para a ocorrência de NIC, tais como: idade média bem abaixo de 75 anos; baixo volume infundido de contraste (em nosso estudo a média de volume infundido foi de 137,3 ml, bem abaixo dos cut offs de risco na literatura: para alguns > 200 ml 16 e para outros > 300 ml 12 ); média baixa de creatinina sérica na admissão com apenas quatro pacientes com creatinina sérica maior do que 2 mg/dL, o que impediu comparações de valor estatístico entre pacientes com creatinina menor e igual versus maior do que 2 mg/ dL (limite de creatinina que costuma ser utilizado como de risco para NIC); poucos pacientes com ICPP prévia; tempo médio de isquemia inferior a 6 horas. ICPP prévia e tempo de isquemia superior a seis horas foram fatores de risco em estudos anteriores.…”