title: Impact of contrast-induced acute kidney injury definition on clinical outcomes.
abstract: BACKGROUND
  Contrast-induced acute kidney injury (CIAKI) is a frequent complication after infusion of contrast media in patients undergoing percutaneous coronary intervention. A wide range of CIAKI rates occurs after intervention between 3% and 30%, depending on the definition. The aim of this study was to identify which methodology was more effective at recognizing patients at high risk for in-hospital and out-of-hospital adverse events.
  
  
  RESULTS
  Serum creatinine increases, after contrast agent infusion, were evaluated in 755 consecutive and unselected patients. Incidences of CIAKI diagnosed by 2 common definitions varied from 6.9% (creatinine increase of ≥0.5 mg/dL, CIAKI-0.5) to 15.9% (creatinine increase of ≥25%, CIAKI-25%). Significant differences appeared between the 2 definitions of sensitivity to predict renal failure according to receiver operating characteristic curve analysis (98% for CIAKI-0.5 and 62% for CIAKI-25%), using a cutoff value of postprocedural glomerular filtration rate of 60 mL/min. Both definitions of CIAKI were related to composite adverse events, but CIAKI-0.5 showed a stronger predicting value (odds ratio 2.875 vs 1.802, P = .036). In multivariate linear regression, only CIAKI-0.5 was a predictive variable of death (odds ratio 3.174, 95% CI 1.368-7.361).
  
  
  CONCLUSIONS
  An increase in serum creatinine of ≥0.5 mg/dL is more sensitive because it recognizes more selectively those patients with a higher risk of mortality and morbidity. Serum creatinine increases of ≥25% overestimate CIAKI by including many patients without postprocedural relevant deterioration of renal function and affected by a lower risk of adverse events at follow-up.
authors.affiliation: Cardiovascular Department, San Giovanni Battista Hospital, Turin, Italy. carlo.budano@fastwebnet.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Budano
authors.forename: Mario
authors.initials: M
authors.lastname: Levis
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Amico
authors.forename: Tullio
authors.initials: T
authors.lastname: Usmiani
authors.forename: Antonella
authors.initials: A
authors.lastname: Fava
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Sbarra
authors.forename: Manuel
authors.initials: M
authors.lastname: Burdese
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Segoloni
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Marra
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects*; D003327:Coronary Disease / Q000000981:diagnostic imaging; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D003287:Contrast Media; D003404:Creatinine