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Development and Validation of Nomogram to Predict Acute Kidney Injury in Patients with Acute Myocardial Infarction Treated Invasively.

ABSTRACT: To identify patients who are likely to develop contrast-induced acute kidney injury (CI-AKI) in patients with acute myocardial infarction (AMI), a nomogram was developed in AMI patients. Totally 920 patients with AMI were enrolled in our study. The discrimination and calibration of the model were validated. External validations were also carried out in a cohort of 386 AMI patients. Our results showed in the 920 eligible AMI patients, 114 patients (21.3%) developed CI-AKI in the derivation group (n?=?534), while in the validation set (n?=?386), 50 patients (13%) developed CI-AKI. CI-AKI model included the following six predictors: hemoglobin, contrast volume >100?ml, hypotension before procedure, eGFR, log BNP, and age. The area under the curve (AUC) was 0.775 (95% confidence interval [CI]: 0.732-0.819) in the derivation group and 0.715 (95% CI: 0.631-0.799) in the validation group. The Hosmer-Lemeshow test has a p value of 0.557, which confirms the model's goodness of fit. The AUC of the Mehran risk score was 0.556 (95% CI: 0.498-0.615) in the derivation group. The validated nomogram provided a useful predictive value for CI-AKI in patients with AMI.

SUBMITTER: Zhou X

PROVIDER: S-EPMC6021383 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Development and Validation of Nomogram to Predict Acute Kidney Injury in Patients with Acute Myocardial Infarction Treated Invasively.

Zhou Xuejun X Sun Zhiqin Z Zhuang Yi Y Jiang Jianguang J Liu Nan N Zang Xuan X Chen Xin X Li Haiyan H Cao Haitao H Sun Ling L Wang Qingjie Q

Scientific reports 20180627 1

To identify patients who are likely to develop contrast-induced acute kidney injury (CI-AKI) in patients with acute myocardial infarction (AMI), a nomogram was developed in AMI patients. Totally 920 patients with AMI were enrolled in our study. The discrimination and calibration of the model were validated. External validations were also carried out in a cohort of 386 AMI patients. Our results showed in the 920 eligible AMI patients, 114 patients (21.3%) developed CI-AKI in the derivation group ...[more]

PMID: 29950662

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Project description:Growth differentiation factor-15 (GDF-15) is an emerging biomarker for risk stratification in cardiovascular disease. Contrast-induced acute kidney injury (AKI) is an important complication in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). In this retrospectively observational study, we aimed to determine the role of GDF-15 and the risk of AKI in acute myocardial infarction (AMI) patients.The medical records of 1195 patients with AMI were reviewed. After exclusion criteria, a total of 751 eligible patients who underwent CAG or PCI were studied. Preoperative clinical parameters including GDF-15 levels were recorded. Multivariate logistic regression analysis was used to identify the risk factors of AKI. Subsequently, to reduce a potential selection bias and to balance differences between the two groups, a propensity score-matched analysis was performed. We recorded the 30-day all-cause mortality of the total study population. Kaplan-Meier analysis was performed to identify the association between short term survival in AMI patients and GDF-15 level.Among 751 enrolled patients, 106 patients (14.1%) developed AKI. Patients were divided into two groups: AKI group (n = 106) and non-AKI group (n = 645). GDF-15 levels were significantly higher in AKI group compared to non-AKI group (1328.2 ± 349.7 ng/L vs. 1113.0 ± 371.3 ng/L, P <0.001). Multivariate logistic regression analyses showed GDF-15 was an independent risk factor of AKI (per 1000 ng/L increase of GDF-15, OR: 3.740, 95% CI: 1.940-7.207, P < 0.001). According to GDF-15 tertiles, patients were divided into three groups. Patients in middle (OR 2.93, 95% CI: 1.46-5.89, P = 0.003) and highest GDF-15 tertile (OR 3.72, 95% CI: 1.87-7.39, P <0.001) had higher risk of AKI compared to patients in the lowest GDF-15 tertile. The propensity score-matched group set comprised of 212 patients. Multivariate logistic regression revealed that GDF-15 is still an independent risk factor for AKI after matching (per 1000 ng/L increase of GDF-15, OR: 2.395, 95% CI: 1.020-5.626, P = 0.045). Based on the Kaplan-Meier analysis, the risk of 30-day all-cause mortality increased in higher GDF-15 tertiles log rank chi-square: 29.895, P <0.001).This suggests that preoperative plasma GDF-15 is an independent risk factor of AKI in AMI patients underwent CAG or PCI. GDF-15 and AKI are associated with poor short term survival of AMI patients.

Project description:BACKGROUND:We aimed to develop a nomogram based on preprocedural features for early prediction of acute kidney injury (AKI) and to assess the prognosis in patients after radical and partial nephrectomy. METHODS:The study included a development cohort of 1111 patients who were treated between June 2012 and June 2017 and an additional validation cohort of 356 patients who were treated between July 2017 and June 2018. Stepwise regression and logistic regression analyses were used to evaluate the association between predictors and AKI. Incorporating all independent predictors, a nomogram for postoperative AKI was developed and externally validated. Patients were followed up for 5 years to assess renal function, acute kidney disease (AKD), chronic kidney disease (CKD), hospital readmission and mortality were key prognosis we focused on. RESULTS:After multivariate logistic regression, radical nephrectomy (odds ratio (OR)?=?3.57, p?<?0.001), aspirin (OR?=?1.79, p?=?0.008), systolic blood pressure (OR?=?1.41, p?=?0.004), triglyceride (OR?=?1.26, p?=?0.024), and alkaline phosphatase (OR?=?1.75, p?=?0.034) were independent risk factors for postoperative AKI, while albumin (OR?=?0.72, p?=?0.031) was a protective factor for postoperative AKI. Patients with a higher estimated glomerular filtration rate (eGFR) (60-90?ml/min/1.73?m2, OR?=?0.41, p?=?0.004; ? 90?ml/min/1.73?m2, OR?=?0.37, p?<?0.001) were less prone to AKI than those with a lower eGFR (<?15?ml/min/1.73?m2). These predictors were all included in the final nomogram. The area under the receiver operating characteristics curve for the model were 0.77 (p?<?0.001) in the development cohort and 0.72 (p?<?0.001) in the validation cohort. The incidence of AKD and CKD were 27.12 and 18.64% in AKI group, which were much higher than those in no AKI group (p?<?0.001). CONCLUSIONS:The nomogram had excellent predictive ability and might have significant clinical implications for the early detection of AKI in patients undergoing nephrectomy.

Project description:BackgroundData on the association between obesity and acute kidney injury (AKI) in patients with ST-elevation myocardial infarction (STEMI) are sparse and inconclusive. We aimed to evaluate the association between obesity and AKI and the outcome in these patients.MethodsA retrospective observational study of 3979 STEMI patients undergoing percutaneous coronary intervention (PCI) was performed at a single center. Patients with and without AKI were compared. Patients were also divided into three categories according to BMI, and these were compared. All-cause mortality was determined at 30 days and over a median period of 7.0 years.ResultsThe incidence of AKI was similar in all BMI categories. There was no association between BMI categories and AKI (p = 0.089). The Spearman correlation coefficient between BMI categories and AKI showed no correlation (r = -0.005; p = 0.75). More AKI patients died within 30 days and in the long term [137 (18.5%) and 283 (38.1%) patients in the AKI group died compared to 118 (3.6%) and 767 (23.1%) in the non-AKI group; p < 0.0001]. AKI was harmful in all BMI categories (p < 0.0001) and was associated with more than a 2.5-fold and a 1.5-fold multivariable-adjusted 30-day and long-term mortality risk, respectively (aOR 2.59; 95% CI 1.84-3.64; p < 0.0001, aHR 1.54; 95% CI 1.32-1.80; p < 0.0001). BMI categories were not associated with 30-day mortality (p = 0.26) but were associated with long-term mortality (p < 0.0001). Overweight and obese patients had an approximately 25% lower long-term multivariable-adjusted risk of death than normal-weight patients. In patients with AKI, BMI was only associated with long-term risk (p = 0.022). Obesity had an additional beneficial effect in these patients, and only patients with obesity, but not overweight patients, had a lower multivariable adjusted long-term mortality risk than normal-weight patients (aHR 062; 95% CI 0.446-0.88 p = 0.007).ConclusionsIn patients who experienced AKI, obesity had an additional positive modifying effect. Our data suggest that the incidence of AKI in STEMI patients is not BMI-dependent.

Dataset Information

Development and Validation of Nomogram to Predict Acute Kidney Injury in Patients with Acute Myocardial Infarction Treated Invasively.

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Development and Validation of Nomogram to Predict Acute Kidney Injury in Patients with Acute Myocardial Infarction Treated Invasively.

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