Abstract 10944: The Optimal Definition of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions
Background: Multiple definitions exist for contrast induced acute kidney injury (CI-AKI) in the setting of percutaneous coronary interventions (PCI). It is unknown which definition is best associated with adverse events and whether this association is stable across patients with various degrees of baseline renal function.
Hypothesis: We hypothesized that commonly used CI-AKI definitions would not be stable in risk prediction for mortality across the spectrum of renal function. Further, we sought to identify the optimal CI-AKI definition which would be both highly predictive of mortality and stable in its association regardless of baseline renal function.
Methods: We applied logistic regression models to multiple current CI-AKI definitions to examine the impact of baseline renal function on a candidate CI-AKI definition’s correlation with the adverse outcome of mortality. We then utilized Likelihood ratios to examine candidate definitions and identify those where association with mortality remained constant regardless of baseline serum creatinine (SCr). These definitions were then assessed for specificity, sensitivity and positive and negative predictive values to identify an optimal definition.
Results: Our study cohort comprised of 119,554 patients who underwent PCI in the state of Michigan between 2010-2014. Most commonly used definitions were not associated with mortality in a constant fashion across baseline renal function. Of the 266 candidate definitions examined, 16 definition’s association with mortality was not significantly altered by baseline SCr. CI-AKI defined as an absolute increase of SCr ≥ 0.3 mg/dl and a relative SCr increase ≥ 50% was selected as the optimal candidate using Perkins and Shisterman decision theoretic optimality criteria and was highly predictive of and specific for mortality.
Conclusions: We identified the optimal definition for CI-AKI to be an absolute increase in SCr ≥ 0.3 mg/dl and a relative SCr increase ≥ 50%. Further work is needed to validate this definition in independent studies, in other clinical settings, and to establish its utility for clinical trials and quality improvement efforts.
Author Disclosures: J. Parsh: None. M. Seth: None. C. Briguori: None. P. Grossman: None. R. Solomon: None. H. Gurm: None.
- © 2015 by American Heart Association, Inc.