Introduction: Contrast-induced acute kidney injury (CI-AKI) is a frequent complication of percutaneous coronary interventions (PCI). Various groups have developed and validated risk scores for CI-AKI. Although the majority of these risk scores achieve an adequate accuracy, their usability in clinical practice is limited and greatly debated. Objective: With the present study, we aimed to prospectively assess the diagnostic performance of recently published CI-AKI risk scores (up to 2018) in a cohort of patients undergoing PCI. Methods: We enrolled 1,247 consecutive patients (80% men, mean age 62 ± 10 years) treated with elective or urgent PCI. For each patient, we calculated the individual CI-AKI risk score based on 17 different risk models. CI-AKI was defined as an increase of ≥25% (liberal) or ≥0.5 mg/dL (strict) in pre-PCI serum creatinine 48 h after PCI. Results: CI-AKI definition and, therefore, CI-AKI incidence have a significant impact on risk model performance (median negative predictive value increased from 85 to 99%; median c-statistic increased from 0.516 to 0.603 using more strict definition criteria). All of the 17 published models were characterized by a weak-to-moderate discriminating ability mainly based on the identification of “true-negative” cases (median positive predictive value 19% with liberal criterion and 3% with strict criterion). In none of the models, c-statistic was #x3e;0.800 with either CI-AKI definition. Novel, different combinations of the #x3e;35 independent variables used in the published models either by down- or by up-scaling did not result in significant improvement in predictive performance. Conclusions: The predictive ability of all models was similar and only modest, derived mainly by identifying true-negative cases. A new approach is probably needed by adding novel markers or periprocedural characteristics.
Cardiorenal Med 2020;10:162–174

中文翻译：

---

17种造影剂诱发的急性肾损伤风险预测模型的应用。

简介：造影剂引起的急性肾损伤（CI-AKI）是经皮冠状动脉介入治疗（PCI）的常见并发症。各个小组已经开发并验证了CI-AKI的风险评分。尽管这些风险评分中的大多数都达到了足够的准确度，但它们在临床实践中的可用性受到限制，并且存在很大争议。目的：通过本研究，我们旨在前瞻性评估最近发表的CI-AKI风险评分（截至2018年）在一组接受PCI的患者中的诊断性能。方法：我们招募了1,247名接受择期或紧急PCI治疗的患者（男性80％，平均年龄62±10岁）。对于每位患者，我们根据17种不同的风险模型计算出单独的CI-AKI风险评分。CI-AKI定义为PCI后48 h PCI前血清肌酐增加≥25％（自由度）或≥0.5mg / dL（严格）。结果：CI-AKI定义以及因此的CI-AKI发生率对风险模型的性能有重大影响（使用更严格的定义标准，中位阴性预测值从85％增至99％；中位数c统计量从0.516增至0.603）。所有这17个发表的模型的特征都是弱到中等的辨别能力，主要是基于“真阴性”病例的识别（自由标准为中值为19％，严格标准为3％）。在所有模型中，没有一个CI-AKI定义的c统计量为＃x3e; 0.800。通过缩小或放大，在已发布模型中使用的＃x3e; 35自变量的新颖，不同组合并未导致预测性能的显着提高。结论：所有模型的预测能力都是相似的，并且只有中等水平，主要是通过确定真阴性病例得出的。通过添加新的标记或过程外特征可能需要一种新方法。
心血管内科杂志2020; 10：162–174