Risk Predictors Of Contrast-induced Nephropathy (CIN) And The Validity Of The Mehran Score In Predicting CIN

ObjectiveTo explore the risk predictors of contrast-induced nephropathy (CIN) in patientswith coronary angiography (CAG) and/or percutaneous coronary intervention, toidentify the patients with high risk of CIN, and to test the validity of Mehran score(MRS) for CIN in Chinese patients.Methods①802patients with coronary angiography (CAG) and/or percutaneouscoronary intervention (PCI) in Fuxing Hospital Affiliated with Capital MedicalUniversity hospitalized, from2010to2011, were collected. The followinginformation with general situation, the contrast agent volume, renal insufficiency, ahistory of diabetes and hypertension, congestive heart failure (CHF), hypotension,introaortic balloon pump (IABP), statins and angiotensin converting enzymeinhibitors/angiotensin receptor antagonists(ACEI/ARB), and creatinine glomerularfiltration rate (eGFR) were recorded. And the serum creatinine, hematocritcapacity(hct), serum albumin (ALB), high-sensitivity C-reactive protein (hs-CRP),low-density lipoprotein cholesterol (LDL-C) within48to72hours were recorded..②CIN was defined as a relative rise in SCr≥25%, or as an absoluteincrease≥44.2umol/L from base line within48to72hours after the contrast medium,and the acute renal failure were excluded.③We divided the patients into CIN group(64cases) and non-CIN group (738cases) according to postoperative serumcreatinine change. SPSS17.0software was used. The independent t-test ornon-parametric test was used for difference between two groups, and categorical variables were compared by χ~2-test. Multivariate logistic regression analysis was usedfor the risk factors of CIN.(P <0.05was considered statistically significant).④Patients were divided into four groups based on the Mehran score (≤5points,low-risk;6to10, medium risk;11to15at high risk;≥16points, very high risk),the different incidence rates of CIN in every group were compared. TheHosmer-Lemeshow test and c statistic were used to assess the validity of Mehranscore.Results1．The basic clinical characteristics of the patientsThere were441male and361female included,65.7911.93years old.64caseswere diagnosticed CIN, and the incidence of CIN was7.98%. The CIN group wasmore elderly, and with more renal insufficiency, diabetes, IABP, chronic congestiveheart failure, low red blood cell hematocrit, and with more significantly higherincidence of high-sensitivity C-reactive protein, and lower serum albumin level, thedifference was statistically significant (P <0.05); There were no significant differencein age, gender, hypertension, contrast dose, LDL-C application statins and AECI/ARB between the two groups (P>0.05).2. The risk factors for CINlogistic regression analysis showed that renal insufficiency, diabetes, the IABPand low hematocrit are the independent risk predictors for CIN, with OR values as5.086,2.042,2.026and1.694, P <0.05.3. The validity of the Mehran score in predicting CIN3.1、The incidence of CIN in different Mehran risk stratificationThe patients were divided into low-risk, medium risk, high risk and veryhigh-risk group according to the Mehran score, and the CIN rate were4.6%,12.5%,15.7%and23.1%, separately, there are significant difference in the incidence of CIN (P <0.001). While the CIN rates were lower than that in the predict model.3.2、The calibration capacity of Mehran scoreHosmer-Lemeshow goodness of fit test shows chi2=3.292, df=5, P=0.655,suggesting the excellent goodness of fit of Mehran score for CIN.3.3、The discrimination of Mehran scorec test showed the area under ROC was0.669(95%CI:0.598~0.740, P<0.001), indicates the accuracy of Mehran score in predicting CIN is a little lower.Conclusions①Renal insufficiency, diabetes mellitus, IABP and low hematocrit are theindependent risk predictors of CIN;②Mehran risk stratification can effectively predict the incidence of CIN, howerer,the discrimination was a little lower.