两个造影后急性肾损伤预警评分在冠脉介入诊疗术人群中的外部验证和比较

External validation and comparison of two risk scores for predicting post-contrast acute kidney injury in patients undergoing coronary intervention

目的通过外部验证比较“Mehran评分”和“国内评分”这两个造影后急性肾损伤(PC-AKI)预警评分预测的准确性,筛选出更适宜于国人的PC-AKI预警评分。方法连续性收集内蒙古自治区人民医院594例接受冠状动脉造影检查或经皮冠状动脉介入术治疗(PCI)的患者,通过Hosmer-Lemeshow拟合优度检验评价两个评分的校正能力,应用接收者工作特征曲线(ROC)下面积评价两个评分对PC-AKI的判别能力;比较分析两个评分危险分层后其相应的发病率以及与院内不良事件的相关性。结果PC-AKI发病率为5.2%(31/594)。经Hosmer-Lemeshow拟合优度检验,两个评分都有良好的校正能力,国内评分显示χ2=5.98,P=0.43,Mehran评分显示χ2=2.42,P=0.88;但国内评分预测能力优于Mehran评分,国内评分ROC曲线下面积为0.71(95%CI0.61~0.80),而Mehran评分ROC曲线下面积为仅为0.56(95%CI0.48~0.63)。并且按国内评分评估为低危、中危、高危和极高危患者的PC-AKI发病率分别为2.1%、6.2%、18.4%和33.3%(P<0.01);而Mehran评分的低危、中危、高危和极高危患者的PC-AKI发病率分别为10.1%、13.2%、24.0%和25.0%(P=0.125)。此外我国评分还与术后院内不良事件发生相关(OR=1.20,95%CI 1.09~1.32,P<0.01),而Mehran评分并未观察到(OR=1.0695%CI0.99~1.14,P=0.061)。结论两个PC-AKI预警评分都有较好的拟合优度,但国内评分能更好的预测PC-AKI的发生,更适宜应用于我国行冠脉介入诊疗术的人群。

Objective To screen out the more suitable risk score on the prediction of post-contrast acute kidney injury(PC-AKI)for Chinese people,by comparing the accuracy values of the Mehran risk score and the domestic risk score for prediction of PC-AKI through external verification.Methods We consecutively enrolled 594 patients who underwent coronary angiography(CAG)or percutaneous coronary intervention(PCI)in our hospital.The correction ability of the two risk scoring systems was assessed by the Hosmer-Lemeshow goodness-of-fit test.The discrimination for PC-AKI was measured for the two scoring systems by area under the receiver operating characteristic(ROC)curve.Furthermore,the incidence of PC-AKI and the correlation with hospital adverse events were statistically analyzed with the stratification scores of two risk scoring systems.Results The incidence of PC-AKI was 5.2%(31/594)in our hospital.Both the Mehran risk score and domestic risk score showed good correction ability(Hos-mer-Lemeshow statistic test,Mehran risk score,χ2=2.42,P=0.88;and domestic risk score,χ2=5.98,P=0.43,respectively).However,the domestic risk score had a higher predictive accuracy for PC-AKI compared with the Mehran risk score.The area under the ROC curve for the Mehran risk score was 0.56(95%CI 0.48~0.63),while the area under the ROC curve for the domestic risk score was 0.71(95%CI 0.61~0.80).In addition,the rate of PC-AKI was 2.1%,6.2%,18.4%,and 33.3%with the risk categories of low-,moderate-,high-and very high-risk in the domestic risk scoring system,respectively(P<0.01).But the trend was not obviously found for the Mehran risk score,and the incidences of PC-AKI were 10.1%,13.2%,24.0%and 25.0%(P=0.125),respectively,with the risk categories of low-,moderate-,high-and very high-risk.Furthermore,the domestic risk score was highly positively correlated with the incidence of in-hospital adverse event(OR=1.20,95%CI 1.09~1.32,P<0.01).However,this relation did not hold true for the Mehran risk score(OR=1.0695%CI 0.99~1.14,P=0.061).Conclusion Both the Mehran risk score and domestic risk score have a high goodness of fit.But the domestic risk score tends to be more accurate for prediction of PC-AKI.Therefore,the domestic risk score may be more suitable for the Chinese patients undergoing coronary intervention.