title: Acute Kidney Injury Risk Prediction in Patients Undergoing Coronary Angiography in a National Veterans Health Administration Cohort With External Validation.
abstract: BACKGROUND
  Acute kidney injury (AKI) occurs frequently after cardiac catheterization and percutaneous coronary intervention. Although a clinical risk model exists for percutaneous coronary intervention, no models exist for both procedures, nor do existing models account for risk factors prior to the index admission. We aimed to develop such a model for use in prospective automated surveillance programs in the Veterans Health Administration.
  
  
  RESULTS
  We collected data on all patients undergoing cardiac catheterization or percutaneous coronary intervention in the Veterans Health Administration from January 01, 2009 to September 30, 2013, excluding patients with chronic dialysis, end-stage renal disease, renal transplant, and missing pre- and postprocedural creatinine measurement. We used 4 AKI definitions in model development and included risk factors from up to 1 year prior to the procedure and at presentation. We developed our prediction models for postprocedural AKI using the least absolute shrinkage and selection operator (LASSO) and internally validated using bootstrapping. We developed models using 115 633 angiogram procedures and externally validated using 27 905 procedures from a New England cohort. Models had cross-validated C-statistics of 0.74 (95% CI: 0.74-0.75) for AKI, 0.83 (95% CI: 0.82-0.84) for AKIN2, 0.74 (95% CI: 0.74-0.75) for contrast-induced nephropathy, and 0.89 (95% CI: 0.87-0.90) for dialysis.
  
  
  CONCLUSIONS
  We developed a robust, externally validated clinical prediction model for AKI following cardiac catheterization or percutaneous coronary intervention to automatically identify high-risk patients before and immediately after a procedure in the Veterans Health Administration. Work is ongoing to incorporate these models into routine clinical practice.
authors.affiliation: White River Junction VA, Research & Development Service, White River Junction, VT (J.R.B., T.A.M.K.) The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., T.A.M.K.) Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B.) Department of Community and Family Medicine, Geisel School of Medicine, Lebanon, NH (J.R.B., T.A.M.K.).
authors.forename: Jeremiah R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: White River Junction VA, Research & Development Service, White River Junction, VT (J.R.B., T.A.M.K.) The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., T.A.M.K.) Department of Community and Family Medicine, Geisel School of Medicine, Lebanon, NH (J.R.B., T.A.M.K.).
authors.forename: Todd A
authors.initials: TA
authors.lastname: MacKenzie
authors.affiliation: Medical Service, VA Eastern Colorado Health Care System, Denver, CO (T.M.M., T.T.T.) Division of Cardiology, University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.) Clinical Assessment Reporting and Tracking Program, VA Central Office, Denver, CO (T.M.M., M.E.P., J.S.R.).
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN (J.F., E.D.S., M.E.M.) Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (J.F., M.E.M.).
authors.forename: James
authors.initials: J
authors.lastname: Fly
authors.affiliation: Medical Service, VA Eastern Colorado Health Care System, Denver, CO (T.M.M., T.T.T.) Kaiser Permanente of Colorado, Denver, CO (T.T.T.).
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.affiliation: Clinical Assessment Reporting and Tracking Program, VA Central Office, Denver, CO (T.M.M., M.E.P., J.S.R.) Division of Health Systems, Management, and Policy, University of Colorado School of Public Health, Denver, CO (M.E.P.).
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.affiliation: Office of Analytics and Business Intelligence, VA Central Office, Veterans Health Administration, Seattle, WA (C.D.N., C.R.B.) Division of Pulmonary Medicine and Critical Care, University of Nevada, Reno, NV (C.D.N.).
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Nielson
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN (J.F., E.D.S., M.E.M.) Division of Nephrology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (E.D.S.).
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.affiliation: Department of Cardiology, Lahey Clinic, Burlington, MA (F.S.R.).
authors.forename: Frederic S
authors.initials: FS
authors.lastname: Resnic
authors.affiliation: Office of Analytics and Business Intelligence, VA Central Office, Veterans Health Administration, Seattle, WA (C.D.N., C.R.B.).
authors.forename: Clifton R
authors.initials: CR
authors.lastname: Baker
authors.affiliation: Division of Cardiology, University of Colorado School of Medicine, Denver, CO (T.M.M., J.S.R.) Clinical Assessment Reporting and Tracking Program, VA Central Office, Denver, CO (T.M.M., M.E.P., J.S.R.).
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN (J.F., E.D.S., M.E.M.) Division of General Internal Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (J.F., M.E.M.) Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN (M.E.M.) Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (M.E.M.).
authors.forename: Michael E
authors.initials: ME
authors.lastname: Matheny
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D015203:Reproducibility of Results; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
keywords: angiography; angioplasty; catheterization; contrast media; kidney