Acute Kidney Injury Following In-Patient Lower Extremity Vascular Intervention
| Autor: | Kevin F. Kennedy, David M. Safley, Adam C. Salisbury, Thomas T. Tsai, John A. Spertus, Lawrence A. Garcia, R. Kevin Rogers, Anand Prasad, Kenneth Rosenfield, Nicolas W. Shammas, Matthew A. Cavender, Eric A. Secemsky, Faisal Latif |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
urogenital system business.industry Incidence (epidemiology) medicine.medical_treatment Acute kidney injury Renal function 030204 cardiovascular system & hematology urologic and male genital diseases medicine.disease Logistic regression female genital diseases and pregnancy complications 03 medical and health sciences 0302 clinical medicine Internal medicine Heart failure Diabetes mellitus medicine Cardiology 030212 general & internal medicine Cardiology and Cardiovascular Medicine Complication business Dialysis |
| Zdroj: | JACC: Cardiovascular Interventions. 14:333-341 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2020.10.028 |
| Popis: | Objectives The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI. Background AKI is an important and potentially modifiable complication of peripheral vascular intervention (PVI). The incidence, predictors, and outcomes of AKI after PVI are incompletely characterized. Methods A hierarchical logistic regression risk model using pre-procedural characteristics associated with AKI was developed, followed by bootstrap validation. The model was validated with data submitted after model creation. An integer scoring system was developed to predict AKI after PVI. Results Among 10,006 procedures, the average age of patients was 69 years, 58% were male, and 52% had diabetes. AKI occurred in 737 (7.4%) and was associated with increased in-hospital mortality (7.1% vs. 0.7%). Reduced glomerular filtration rate, hypertension, diabetes, prior heart failure, critical or acute limb ischemia, and pre-procedural hemoglobin were independently associated with AKI. The model to predict AKI showed good discrimination (optimism corrected c-statistic = 0.68) and calibration (corrected slope = 0.97, intercept of −0.07). The integer point system could be incorporated into a useful clinical tool because it discriminates risk for AKI with scores ≤4 and ≥12 corresponding to the lower and upper 20% of risk, respectively. Conclusions AKI is not rare after PVI and is associated with in-hospital mortality. The NCDR PVI AKI risk model, including the integer scoring system, may prospectively estimate AKI risk and aid in deployment of strategies designed to reduce risk of AKI after PVI. |
| Databáze: | OpenAIRE |
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