Performance and Validation of the U.S. NCDR Acute Kidney Injury Prediction Model in Japan

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• 作者：Taku Inohara ; MD ; PhD^a ; ^b ; Shun Kohsaka ; MD ; PhD^a ; ^{kohsaka@cpnet.med.keio.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hiroaki Miyata ; PhD^c ; Ikuko Ueda ; PhD^a ; Yuichiro Maekawa ; MD ; PhD^a ; Keiichi Fukuda ; MD ; PhD^a ; David J. Cohen ; MD ; MSc^d ; Kevin F. Kennedy ; MS^d ; John S. Rumsfeld ; MD ; PhD^e ; John A. Spertus ; MD ; MPH^d
• 关键词：external validation ; percutaneous coronary intervention ; risk model ; serum creatinine
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：12 April 2016
• 年：2016
• 卷：67
• 期：14
• 页码：1715-1722
• 全文大小：449 K

文摘

Stratifying patient risk for acute kidney injury (AKI) prior to percutaneous coronary intervention (PCI) can enable clinicians to tailor their approach to minimize AKI. The National Cardiovascular Data Registry (NCDR) CathPCI Registry recently developed 2 prediction models: for AKI and AKI requiring dialysis (AKI-D).

Objectives

This study sought to externally validate the NCDR AKI and AKI-D models in a Japanese population. Determining the generalizability of the U.S. model could support quality improvement efforts in Japan.

Methods

The NCDR prediction models were applied to 11,041 consecutive patients in the Japanese multicenter PCI registry. AKI was defined as an absolute increase ≥0.3 mg/dl or a relative increase of 50% in serum creatinine, in accordance with the definition of AKI Network criteria; AKI-D was defined as initiation of dialysis after PCI. Discrimination and calibration of the NCDR models were tested in the Japanese cohort. If the model was perfectly calibrated, the slope and intercept would equal 1.0 and 0.0, respectively.

Results

In the Japanese PCI cohort, AKI and AKI-D occurred in 10.5% and 1.5% of patients, respectively. The NCDR AKI prediction model showed good discrimination (c-statistic = 0.76) and calibration (slope = 0.93 and intercept = –0.10) in both acute and nonacute PCI. The AKI-D prediction model had good discrimination (c-statistic = 0.92), but while the calibration slope was good (1.04), the intercept was significantly underestimated (0.96). However, this was corrected with recalibration (slope = 1.04 and intercept = –0.087).

Conclusions

In a Japanese population, the NCDR AKI models validly predict post-procedural AKI and, with recalibration, AKI-D. Prospective use of these models to inform clinical decision making should be tested as a means of reducing AKI after PCI in Japan. (Japan Cardiovascular Database, Percutaneous Coronary Intervention Registry; UMIN R000004736).