Risk factors and scoring system in the prediction of contrast induced nephropathy in patients undergoing percutaneous coronary intervention

Objective To develop a simplified risk scoring system of contrast induced nephropathy (CIN) after pereutaneous coronary intervention (PCI).Methods A retrospecttive study was performed on 1500 patients in the development set undergoing PCI from January 2008 to December 2009. And 1000 patients treated from January 2010 to May 2011 were selected for the validation set. Logistic regression analysis was applied to identify the risk factors of CIN.Based on the odds ratio,the sum of integers was a total risk score for each patient.Results ( 1 ) Among them,CIN occurred in 246 patients with an overall incidence of 16.4％. (2) Eleven identified variables were identified as the risk factors of CIN (with weighted integer):diabetes (3 scores),hypotension (3 scores),left ventricular ejection fraction (LVEF ≤45％) (3 scores),eGFR ＜60[ml · min-1 · (1.73 m2) -1](3 scores),age ＞70 years (2 scores),myocardial infarction (2 scores),emergency PCI (2 scores),anemia (2 scores),decreased high-density lipoprotein(HDL) concentration ( ＜1 mmoVL) (2 scores),contrast agent dose ＞200 ml (2 scores) and low permeability contrast agent (1 score).(3) The sum of integers was a total risk score for each patient.The incidence of CIN was 5.2％ in the low-risk group ( ≤4),13.6％ in the moderate-risk group (5 - 10),32.3％ in the high-risk group (11 -14) and 59.0％ in the very-high-risk group (≥15).(4) Good discriminative power was found in the validation population.And the risk score was strongly correlated with CIN(c-statistic =0.82).Conclusion This scoring system provides a good estimate of the risk of CIN after PCI.It may be used for the prevention and treatment of CIN. Key words: Angioplasty,transluminal,percutaneous coronary; Nephrosis; Risk factors; Contrast medium; Incidence