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Acute Kidney Injury Risk Prediction in Patients Undergoing Coronary Angiography in a National Veterans Health Administration Cohort With External Validation.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2015 Dec 11; Vol. 4 (12). Date of Electronic Publication: 2015 Dec 11. - Publication Year :
- 2015
-
Abstract
- Background: Acute kidney injury (AKI) occurs frequently after cardiac catheterization and percutaneous coronary intervention. Although a clinical risk model exists for percutaneous coronary intervention, no models exist for both procedures, nor do existing models account for risk factors prior to the index admission. We aimed to develop such a model for use in prospective automated surveillance programs in the Veterans Health Administration.<br />Methods and Results: We collected data on all patients undergoing cardiac catheterization or percutaneous coronary intervention in the Veterans Health Administration from January 01, 2009 to September 30, 2013, excluding patients with chronic dialysis, end-stage renal disease, renal transplant, and missing pre- and postprocedural creatinine measurement. We used 4 AKI definitions in model development and included risk factors from up to 1 year prior to the procedure and at presentation. We developed our prediction models for postprocedural AKI using the least absolute shrinkage and selection operator (LASSO) and internally validated using bootstrapping. We developed models using 115 633 angiogram procedures and externally validated using 27 905 procedures from a New England cohort. Models had cross-validated C-statistics of 0.74 (95% CI: 0.74-0.75) for AKI, 0.83 (95% CI: 0.82-0.84) for AKIN2, 0.74 (95% CI: 0.74-0.75) for contrast-induced nephropathy, and 0.89 (95% CI: 0.87-0.90) for dialysis.<br />Conclusions: We developed a robust, externally validated clinical prediction model for AKI following cardiac catheterization or percutaneous coronary intervention to automatically identify high-risk patients before and immediately after a procedure in the Veterans Health Administration. Work is ongoing to incorporate these models into routine clinical practice.<br /> (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
- Subjects :
- Aged
Cardiac Catheterization adverse effects
Female
Humans
Logistic Models
Male
Percutaneous Coronary Intervention adverse effects
Reproducibility of Results
Risk Factors
United States epidemiology
Acute Kidney Injury etiology
Coronary Angiography adverse effects
Decision Support Techniques
United States Department of Veterans Affairs statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 4
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 26656858
- Full Text :
- https://doi.org/10.1161/JAHA.115.002136