A simplified bedside model for acute kidney injury prediction after percutaneous coronary intervention

Abstract Background Concern for acute kidney injury (AKI) after percutaneous coronary intervention (PCI) is a major determinant in the decision to pursue cardiac catheterization if otherwise indicated. A bedside AKI risk prediction model derived from the National Cardiovascular Data Registry (NCDR), most recently updated in 2023, employs relatively complex parameters for AKI prediction. Purpose To test the efficacy of a simplified pre-procedural 5-variable bedside score for post-PCI AKI prediction based on the NCDR model. Methods We analyzed our institution’s NCDR-reported catheterization laboratory registry between Q2 2022 and Q1 2023. Inclusion criteria, variable selection, and definitions were based on the NCDR model. A bedside prediction model was validated, including 5 pre-procedural variables: anemia (hemoglobin <10 mg/dl), history of heart failure, stage 4 or 5 chronic kidney disease (glomerular filtration rate <30 mg/dl), cardiac arrest, and shock status. Results We included 840 patients, of which 593 (70.6%) were men. Mean age was 69 (±12.5). Most procedures were performed on an urgent basis (444, 52.9%). AKI developed in 107 (12.7%) patients. Compared to the non-AKI group, patients who developed AKI were older (age 74±11.5 vs 68.3 ±12.5), and more frequently had anemia (23.6% vs 7.4%), diabetes (51.4% vs 35.2%), severe frailty (45.8% vs 23.7%), heart failure (62.6% vs 29.7%), cardiac arrest (13.1% vs 2.9%), CKD (30.8% vs 6%), shock (12.1% vs 1.5%), and mechanical circulatory support (7.5% vs 2.9%), p<0.001. Utilizing integer scores, the simplified bedside model employing 5 pre-procedural variables demonstrated discrimination similar to the bedside NCDR model, with a C-statistic of 0.77 (0.60-0.88) and excellent calibration (intercept of 0.31 and slope of 1.03) (Figure), indicating the robust performance of the model (compared to bedside NCDR model with a C-statistic 0.793, intercept of -0.197, and slope of 0.957). Conclusion A simplified NCDR-based bedside score using 5 pre-procedural variables is an effective tool for predicting AKI as a complication of PCI, with comparable performance to the 2023 updated bedside NCDR AKI risk model.