Incidence of Acute Kidney Injury After Percutaneous Coronary Intervention：Chart Review vs. Claims Data

• Main Authors: Ming-YanJiang, 江銘彥
• Other Authors: Tsung-Hsueh Lu
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/8zu2b2

碩士 === 國立成功大學 === 公共衛生研究所 === 105 === INTRODUCTION: Acute kidney injury (AKI) is a complication of percutaneous coronary intervention (PCI). However, the incidences varied with populations and definitions of AKI. The purpose of this study was to examine the incidence, predictors, and outcome of AKI in PCI patients, and explored the validity of AKI diagnoses in claims data. METHODS: We retrospectively reviewed the medical records of 1,204 patients undergoing PCIs at a tertiary care center. AKI was defined in accordance with the definition of Acute Kidney Injury Network (AKIN) criteria; dialysis-requiring AKI (AKI-D) was defined as initiation of new dialysis after PCI. We also identified the risk factors associated with the development of AKI and AKI-D and the association between AKI and patient outcomes. RESULTS: The incidence of stage 1, 2, 3 AKI and AKI-D were 9.0%, 1.1%, 2.2%, and 4.4%, respectively. The risk factors associated with development of AKI and AKI-D included poorer baseline kidney function, cardiogenic shock, and intra-aortic balloon pump (IABP) insertion. The mean length of stay was 6.77 days and AKI is associated with longer length of stay. AKI and AKI-D were independent predictors of in-hospital mortality. ICD-9-CM codes for AKI in claims data had a sensitivity of 22.39%, specificity of 98.01%, PPV of 69.23%, and NPV of 86.30%. CONCLUSION: We found that AKI developed in 16.7% of patients, 4.4% of whom required acute dialysis. Baseline renal function markedly increased the risk of the development of AKI or AKI-D. Patients with AKI or AKI-D experienced high risk of in-hospital mortality. Identifying AKI in PCI patients using administrative diagnostic codes will result in an underestimation of the true incidence.