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Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY - Medicine (Baltimore) (2015)

Bottom Line: Thirty-nine patients (3.8%) developed CIN.There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001).After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

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ROC curve for the prediction of CIN using the V/CrCl, V/MDRD, and Mehran risk score. AUC = area under the curve, CIN = contrast-induced nephropathy, CM = contrast media, ROC = receiver operating characteristic, V/CrCl = CM volume to creatinine clearance, V/MDRD = volume to Modification of Diet in Renal Disease equation.
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Figure 2: ROC curve for the prediction of CIN using the V/CrCl, V/MDRD, and Mehran risk score. AUC = area under the curve, CIN = contrast-induced nephropathy, CM = contrast media, ROC = receiver operating characteristic, V/CrCl = CM volume to creatinine clearance, V/MDRD = volume to Modification of Diet in Renal Disease equation.

Mentions: ROC curve analysis demonstrated that the area under the curve (AUC) for the V/CrCl ratio was 0.680 for CIN. For the Mehran risk score, the AUC was similar to the V/CrCl ratio for CIN (0.735, P = 0.204). The Youden index demonstrated that the optimal cut off level for the V/CrCl ratio was >2.74, which exhibited 76.2% sensitivity and 70.6% specificity for predicting CIN. Although there was no significant difference between the V/CrCl and the V/MDRD, the AUC of the V/MDRD (0.648) was lower than the V/CrCl (Figure 2).


Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.

Liu Y, Liu YH, Chen JY, Tan N, Zhou YL, Duan CY, Yu DQ, Xie NJ, Li HL, Chen PY - Medicine (Baltimore) (2015)

ROC curve for the prediction of CIN using the V/CrCl, V/MDRD, and Mehran risk score. AUC = area under the curve, CIN = contrast-induced nephropathy, CM = contrast media, ROC = receiver operating characteristic, V/CrCl = CM volume to creatinine clearance, V/MDRD = volume to Modification of Diet in Renal Disease equation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553999&req=5

Figure 2: ROC curve for the prediction of CIN using the V/CrCl, V/MDRD, and Mehran risk score. AUC = area under the curve, CIN = contrast-induced nephropathy, CM = contrast media, ROC = receiver operating characteristic, V/CrCl = CM volume to creatinine clearance, V/MDRD = volume to Modification of Diet in Renal Disease equation.
Mentions: ROC curve analysis demonstrated that the area under the curve (AUC) for the V/CrCl ratio was 0.680 for CIN. For the Mehran risk score, the AUC was similar to the V/CrCl ratio for CIN (0.735, P = 0.204). The Youden index demonstrated that the optimal cut off level for the V/CrCl ratio was >2.74, which exhibited 76.2% sensitivity and 70.6% specificity for predicting CIN. Although there was no significant difference between the V/CrCl and the V/MDRD, the AUC of the V/MDRD (0.648) was lower than the V/CrCl (Figure 2).

Bottom Line: Thirty-nine patients (3.8%) developed CIN.There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001).After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology (YL, J-yC, NT, Y-lZ, D-qY, N-jX, H-lL), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; Department of cardiology, Guangdong General Hospital, Southern Medical University (Y-hL); and Department of Biostatistics (C-yD, P-yC), School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China.

ABSTRACT
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ≥65 years) with relative normal renal function (baseline serum creatinine <1.5 mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic = 0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio = 3.21, 95% confidence interval [CI] 1.45-7.09, P = 0.004) and worse long-term mortality (hazard ratio = 1.96, 95% CI 1.14-3.38, P = 0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function.

Show MeSH
Related in: MedlinePlus