An Online Pre-procedural Nomogram for the Prediction of Contrast-Associated Acute Kidney Injury in Patients Undergoing Coronary Angiography

Frontiers in Medicine

article

Duanbin Li¹  Hangpan Jiang³  Xinrui Yang¹  Maoning Lin¹  Menghan Gao⁵  Zhezhe Chen¹  Guosheng Fu¹  Dongwu Lai¹  Wenbin Zhang¹ 

[1] Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University;Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province;Department of Cardiology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University;Department of Cardiology, The Hangzhou Lin’an People’s Hospital;College of Medicine, Zhejiang University

关键词: contrast-associated acute kidney injury;    nomogram;    coronary artery disease;    coronary angiography;    percutaneous coronary intervention;   

DOI  :  10.3389/fmed.2022.839856

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Identifying high-risk patients for contrast-associated acute kidney injury (CA-AKI) helps to take early preventive interventions. The current study aimed to establish and validate an online pre-procedural nomogram for CA-AKI in patients undergoing coronary angiography (CAG). Methods In this retrospective dataset, 4,295 patients undergoing CAG were enrolled and randomized into the training or testing dataset with a split ratio of 8:2. Optimal predictors for CA-AKI were determined by Least Absolute Shrinkage and Selection Operator (LASSO) and Random Forest (RF) algorithm. Nomogram was developed and deployed online. The discrimination and accuracy of the nomogram were evaluated by receiver operating characteristic (ROC) and calibration analysis, respectively. Clinical usefulness was estimated by decision curve analysis (DCA) and clinical impact curve (CIC). Results A total of 755 patients (17.1%) was diagnosed with CA-AKI. 7 pre-procedural predictors were identified and integrated into the nomogram, including age, gender, hemoglobin, N-terminal of the prohormone brain natriuretic peptide, neutrophil-to-lymphocyte ratio, cardiac troponin I, and loop diuretics use. The ROC analyses showed that the nomogram had a good discrimination performance for CA-AKI in the training dataset (area under the curve, AUC = 0.766, 95%CI [0.737 to 0.794]) and testing dataset (AUC = 0.737, 95%CI [0.693 to 0.780]). The nomogram was also well-calibrated in both the training dataset ( P = 0.965) and the testing dataset ( P = 0.789). Good clinical usefulness was identified by DCA and CIC. Finally, this model was deployed in a web server for public use ( https://duanbin-li.shinyapps.io/DynNomapp/ ). Conclusion An easy-to-use pre-procedural nomogram for predicting CA-AKI was established and validated in patients undergoing CAG, which was also deployed online.

【 授权许可】

CC BY