Kidney Week

Abstract: FR-PO044

Evaluation of Scoring Tools to Predict AKI Postpercutaneous Coronary Intervention

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Hudson, Joanna Q., The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Joanna Q. Hudson, PharmD, FASN

• Parnacott, Tara, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Tara Parnacott, PharmD

• Jacobs, Anna R., Methodist Le Bonheur Healthcare, Memphis, Tennessee, United States

Anna R. Jacobs, PharmD

• Cummings, Carolyn, Methodist Le Bonheur Healthcare, Memphis, Tennessee, United States

Carolyn Cummings

• Hastings, Margaret Colleen, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Margaret Colleen Hastings, MD

• Duhart, Benjamin, The University of Tennessee Health Science Center, Memphis, Tennessee, United States

Benjamin Duhart, PharmD

Background

Radiocontrast-associated acute kidney injury (CA-AKI) is a common cause of in-hospital acute kidney injury (AKI) and other causes of morbidity and mortality. The original Mehran score was developed to predict risk of developing CA-AKI after percutaneous coronary intervention (PCI); however, it requires intraprocedural variables such as contrast volume and cannot proactively identify high-risk patients. The modified Mehran 2 (MM2) score and the CHA₂DS₂-VASc score overcome this limitation, but validation in the clinical setting is limited. This study evaluated the MM2 and CHA₂DS₂-VASc score for prediction of AKI in patients receiving iodinated contrast for PCI.

Methods

A retrospective chart review was conducted of adults (≥ 18 years) admitted to Methodist LeBonheur Hospitals in Memphis, Tennessee between July 2019 and July 2023 who received contrast for PCI. Patients with end-stage kidney disease, AKI prior to receipt of contrast, or with a documented contrast allergy were excluded. MM2 and CHA₂DS₂-VASc scores were evaluated in patients with and without CA-AKI using previously proposed thresholds for high risk (MM2 ≥ 8; CHA₂DS₂-VASc ≥ 4). Predictive ability was analyzed using receiver operating characteristic (ROC) curves for comparison of area under the curve (AUC); p-value < 0.05 considered statistically significant. Other factors associated with AKI not included in the MM2 and CHA₂DS₂-VASc were also evaluated.

Results

One hundred seventy-seven patients were included: 128 without CA-AKI (72.3%), 49 with CA-AKI (27.7%). The MM2 and CHA₂DS₂-VASc scores performed similarly for predicting CA-AKI (ROC AUC 0.68 and 0.67, respectively). The proportion of patients with a high/very high-risk MM2 score was greater in the CA-AKI group (55% vs. 32%; p=0.005). Similarly, more patients in the CA-AKI group had a high-risk CHA₂DS₂-VASc score (51% vs. 31%; p=0.011). The CA-AKI group had a higher rate of hypotension within 48 hours of PCI (41% vs. 12%; p<0.001) and was less likely to have received pre-procedure IV fluids (35% vs. 52%; p=0.035). Patients with CA-AKI had longer hospital length-of-stay (5.3 vs. 3.1 days; p<0.001).

Conclusion

The MM2 and CHA₂DS₂-VASc scores had similar predictive value for CA-AKI after PCI and may provide a practical advantage over the original Mehran score.