Predictors of contrast induced nephropathy and the applicability of the Mehran risk score in high risk patients undergoing coronary angioplasty—A study from a tertiary care center in South India

Valappil, Sanjai Pattu; Kunjukrishnapillai, Sivaprasad; Iype, Mathew; Koshy, A. George; Viswanathan, Sunitha; Gupta, Prabha Nini; Velayudhan, Radhakrishnan Vellikatu; Ali, Faeez Mohamad

doi:10.1016/j.ihj.2017.08.018

Cited by 19 publications

(20 citation statements)

References 28 publications

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“…[19][20][21][22][23][24][25][26][27][28] Recent studies have demonstrated the external validity of the Mehran score in populations from Spain, Japan, India, and those undergoing computed tomography imaging or transcatheter aortic valve implantation. [29][30][31][32][33][34][35] Furthermore, the Mehran score was validated to predict CIN in the setting of non-urgent PCI as well as primary PCI in patients with acute myocardial infarction. 34,36 However, the inclusion of contrast volume, which cannot be obtained until after the procedure, limits the utility of this score as a predictor of AKI before the procedure.…”

Section: Discussionmentioning

confidence: 99%

Performance of a pre‐procedural Mehran score to predict acute kidney injury after percutaneous coronary intervention

et al. 2020

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Aim: Acute kidney injury (AKI) is a known complication of patients undergoing cardiac catheterization or percutaneous coronary interventions (PCI).The Mehran score was developed to identify patients at risk for AKI after cardiac catheterization or PCI, but its use of contrast volume as part of the score calculation limits its application prior to the procedure. In this study, we evaluated the utility of a modified Mehran score that utilizes only pre-procedural data by excluding contrast volume. Methods: This was done in a retrospective fashion using data from patients who received PCI at our institution between July 2015 and December 2017 by evaluating the discriminative ability of the scoring systems for predicting outcomes through a receiver-operator characteristic curve analysis. Results: One thousand five hundred and seven patients were included in the study. A total of 70 (4.6%) patients developed AKI. The removal of contrast volume from the Mehran score resulted in a small loss of discrimination with AUROC 0.73 vs 0.74, P = .01 for the pre-procedural Mehran and the original Mehran, respectively. When compared to the original score, the pre-procedural Mehran score had a four-category net discrimination index (NRI) of-0.10 and an integrated discrimination index (IDI) for of −0.12. Conclusion: Despite a small loss in discrimination, there was no difference in the four-category net discrimination index between the two scores. The pre-procedural modified Mehran score is a useful clinical predictor of the risk of AKI in patients undergoing PCI. K E Y W O R D S acute kidney injury, cardiac catheterizations, Mehran score, percutaneous coronary interventions More than two million cardiac catheterizations and percutaneous coronary interventions (PCI) are performed in the United States each year. 1 Acute kidney injury (AKI) is a common complication in these patients, affecting 3% to 14% of cases. 2 AKI after PCI is associated with increased mortality, increased risk of cardiac events, and progression of chronic kidney disease (CKD), prolonged hospital stay, and higher healthcare costs. 3-8 The National Quality Forum established a patient safety objective to reduce the prevalence of AKI related to contrast administration 9 and the Kidney Disease Improving Global Outcomes (KDIGO) published guidelines for AKI prevention, which include screening for patients at risk and initiating volume expansion in those at high risk. 10 Multiple scores have been developed to identify patients at risk for AKI after cardiac catheterization or PCI. The Mehran score is one

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Section: Discussionmentioning

confidence: 99%

Performance of a pre‐procedural Mehran score to predict acute kidney injury after percutaneous coronary intervention

et al. 2020

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“…Hemoglobin levels and GFR were found to be predictors of CIN in patients treated with emergency PCI. 28,29 Mendi et al determined that there was a relationship between serum uric acid levels and CIN in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary PCI. 30 The association of new risk factor profile, which includes white blood cell count, body surface area, history of stroke, baseline SCr, intra-aortic balloon pump, and diuretics usage, with CIN in patients treated with emergency PCI was also reported.…”

Section: Discussionmentioning

confidence: 99%

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

2018

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Contrast-induced nephropathy (CIN) is acute kidney failure that occurs after exposure to contrast agent. There is no sensitive biomarker to predict the development of CIN. In a retrospective study, we investigated the predictive value of the fibrinogen to albumin ratio (FAR) to determine the risk of CIN in patients (N = 246) who underwent carotid angiography. Contrast-induced nephropathy was defined as a 0.5 mg/dL or 25% increase in serum creatinine levels 48 to 72 hours following exposure to a radiocontrast agent. Patients were grouped according to whether they developed CIN or not, that is, CIN(–) and CIN(+) groups, respectively. Contrast-induced nephropathy developed in 39 (15.8%) of all the patients. The fibrinogen levels, neutrophil to lymphocyte ratio (NLR), and FAR in the CIN (+) group were higher than in the CIN (−) group ( P < .001). Multivariate analysis showed that age, diabetes, NLR, platelet–lymphocyte ratio, and FAR were independent risk factors for CIN. The area under the curve (AUC) of FAR was 0.800 for the prediction of CIN, and the best cutoff value was 57.4 with sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 60.8%, 26.4%, and 92.7%, respectively. The FAR may be useful as a predictor of CIN.

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“…They included PCI patients with normal renal parameters and excluded patients with risk of CIN such as known chronic kidney disease (stage 5), baseline creatinine >1.5 mg/dl, significant hypotension, anaemia and patients with myocardial infarction. Another study by Valappil et al [6] from Trivandrum, Kerala found a CIN incidence of 29 % where they included only patients with impaired renal function (GFR of 30-60 ml/min/ 1.73 m 2 ) and excluded patients with ST elevated myocardial infarction and cardiogenic shock as well as patients undergoing haemodialysis or peritoneal dialysis. These inconsistencies of inclusion and exclusion criteria may be a reason for the variability in incidence of CIN as both the studies used the same definition of CIN as ours.…”

Section: Resultsmentioning

confidence: 99%

“…Reported incidence of CIN varies (<2 to 30 %) depending up on the study population, the prevalence of associated risk factors and the definition of CIN [3,[6][7][8] . Patients undergoing coronary angiography or PCI have the highest CIN incidence compared to other procedures using contrast media for diagnostic or therapeutic purposes.…”

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confidence: 99%

Incidence and Predictors of Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Interventions at an Indian Tertiary Care Center

Sasidharan¹,

James²,

Menon³

2019

pharmaceutical-sciences

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Percutaneous coronary intervention (PCI), a procedure used to open clogged coronary arteries, involves temporary insertion and inflation of a balloon into the stenosed artery in order to widen it. A metallic scaffold, either bare metal or drug eluting, is often inserted during the procedure (coronary stenting) to maintain the patency of the artery and to decrease the chances of restenosis. This intervention needs visualization of the blood vessels by way of injecting a radio-contrast agent during fluoroscopy. The incidence of renal insufficiency is elevated in patients subjected to PCI due to the use of radiographic contrast media in angiographic procedures. Contrast-induced nephropathy (CIN), also known as contrast-induced acute kidney injury (AKI), is a self-generated renal injury that occurs after intra-arterial administration of radio-opaque contrast media [1]. The European Society of Urogenital Radiology (ESUR) defines CIN as an elevation of serum creatinine of >25 % or ≥0.5 mg/dl absolute value compared to the baseline within 48-72 h following the administration of radio-opaque contrast media in the absence of other alternative causes of AKI [2]. The pathophysiology of CIN identifies that the ascending loop of Henle has an increased exposure to ischemia where oxygen requirement is high due to active sodium re-absorption [3]. Following the intra

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Predictors of contrast induced nephropathy and the applicability of the Mehran risk score in high risk patients undergoing coronary angioplasty—A study from a tertiary care center in South India

Abstract: The incidence of CIN in high risk patients undergoing PCI is substantially higher in our population compared to similar studies in the west. The MRS risk prediction is pertinent even in an Indian population.

Cited by 19 publications

References 28 publications

Performance of a pre‐procedural Mehran score to predict acute kidney injury after percutaneous coronary intervention

Performance of a pre‐procedural Mehran score to predict acute kidney injury after percutaneous coronary intervention

The Ratio of Fibrinogen to Albumin as a Predictor of Contrast-Induced Nephropathy After Carotid Angiography

Incidence and Predictors of Contrast-induced Nephropathy in Patients Undergoing Percutaneous Coronary Interventions at an Indian Tertiary Care Center

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