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A Novel Preoperative Risk Assessment Tool to Identify Patients at Risk of Contrast-Associated Acute Kidney Injury After Endovascular Abdominal Aortic Aneurysm Repair

Braet, Drew J. ; Graham, Nathan J. ; Albright, Jeremy ; Osborne, Nicholas H. ; Henke, Peter K.

Annals of vascular surgery, 2023-07, Vol.93, p.79-91 [Periódico revisado por pares]

Netherlands: Elsevier Inc

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  • Título:
    A Novel Preoperative Risk Assessment Tool to Identify Patients at Risk of Contrast-Associated Acute Kidney Injury After Endovascular Abdominal Aortic Aneurysm Repair
  • Autor: Braet, Drew J. ; Graham, Nathan J. ; Albright, Jeremy ; Osborne, Nicholas H. ; Henke, Peter K.
  • Assuntos: Acute Kidney Injury - chemically induced ; Acute Kidney Injury - diagnosis ; Aortic Aneurysm, Abdominal - complications ; Aortic Aneurysm, Abdominal - diagnostic imaging ; Aortic Aneurysm, Abdominal - surgery ; Blood Vessel Prosthesis Implantation - adverse effects ; Creatinine ; Endovascular Procedures - adverse effects ; Female ; Humans ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Outcome
  • É parte de: Annals of vascular surgery, 2023-07, Vol.93, p.79-91
  • Notas: ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
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  • Descrição: Contrast-associated acute kidney injury (CA-AKI) after endovascular abdominal aortic aneurysm repair (EVAR) is associated with mortality and morbidity. Risk stratification remains a vital component of preoperative evaluation. We sought to generate and validate a preprocedure CA-AKI risk stratification tool for elective EVAR patients. We queried the Blue Cross Blue Shield of Michigan Cardiovascular Consortium database for elective EVAR patients and excluded those on dialysis, with a history of renal transplant, death during procedure, and without creatinine measures. Association with CA-AKI (rise in creatinine > 0.5 mg/dL) was tested using mixed-effects logistic regression. Variables associated with CA-AKI were used to generate a predictive model via a single classification tree. The variables selected by the classification tree were then validated by fitting a mixed-effects logistic regression model into the Vascular Quality Initiative dataset. Our derivation cohort included 7,043 patients, 3.5% of whom developed CA-AKI. After multivariate analysis, age (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.004–1.040), female sex (OR 1.393, CI 1.012–1.916), glomerular filtration rate (GFR) < 30 mL/min (OR 5.068, CI 3.255–7.891), current smoking (OR 1.942, CI 1.067–3.535), chronic obstructive pulmonary disease (OR 1.402, CI 1.066–1.843), maximum abdominal aortic aneurysm (AAA) diameter (OR 1.018, CI 1.006–1.029), and presence of iliac artery aneurysm (OR 1.352, CI 1.007–1.816) were associated with increased odds of CA-AKI. Our risk prediction calculator demonstrated that patients with a GFR < 30 mL/min, females, and patients with a maximum AAA diameter of > 6.9 cm are at a higher risk of CA-AKI after EVAR. Using the Vascular Quality Initiative dataset (N = 62,986), we found that GFR < 30 mL/min (OR 4.668, CI 4.007–5.85), female sex (OR 1.352, CI 1.213–1.507), and maximum AAA diameter > 6.9 cm (OR 1.824, CI 1.212–1.506) were associated with an increased risk of CA-AKI after EVAR. Herein, we present a simple and novel risk assessment tool that can be used preoperatively to identify patients at risk of CA-AKI after EVAR. Patients with a GFR < 30 mL/min, maximum AAA diameter > 6.9 cm, and females who are undergoing EVAR may be at risk for CA-AKI after EVAR. Prospective studies are needed to determine the efficacy of our model. •Patients undergoing elective endovascular abdominal aortic aneurysm repair (EVAR) are at risk of contrast-associated acute kidney injury (CA-AKI).•Patients with decreased renal function (glomerular filtration rate < 30 mL/min) are at higher risk of CA-AKI after EVAR.•Patients with a maximum abdominal aortic aneurysm diameter more than 6.9 cm are at higher risk of CA-AKI after EVAR.•Female patients regardless of maximum abdominal aortic aneurysm diameter are at higher risk of CA-AKI after EVAR.
  • Editor: Netherlands: Elsevier Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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