Key result
Novel six-variable risk score predicts post-TAVR acute kidney injury with a c-statistic of ~0.71.
Why the study?
Acute kidney injury is a common complication after TAVR associated with poor prognosis, and a risk calculator using pre-procedural information was needed.
Can a pre-procedural risk score accurately predict acute kidney injury after transcatheter aortic valve replacement?
Observational (n=1,993)
Yes
Can a pre-procedural risk score accurately predict acute kidney injury after transcatheter aortic valve replacement?
Effect estimate: c-statistic 0.713
A simple, 6-variable pre-procedural risk score can predict the risk of acute kidney injury after TAVR with good discrimination, potentially aiding in clinical decision-making and identifying high-risk patients.
May aid pre-TAVR risk stratification; leaves open whether score-guided care reduces AKI.
Background: Acute kidney injury (AKI) is a common post-transcatheter aortic valve replacement (TAVR) complication associated with a poor prognosis. We sought to create a risk calculator using information that would be available during the work-up period. Methods: Data were obtained from a multicentre TAVR registry (n=1993) with cases from 1 January 2012 to 31 December 2015. We used logistic regression to create a risk calculator to predict AKI as defined by the Valve Academic Research Consortium Guidelines. We internally validated our risk calculator using bootstrapping, and evaluated model discrimination and calibration. Results: A simple risk score was derived with six variables, including New York Heart Association functional classification class 4, non-femoral access site, valve-in-valve procedure, haemoglobin, creatinine clearance and weight in kilograms. The score was able to predict the absolute risk of AKI from 1% to 72%. The model showed good discrimination with c-statistic 0.713, with good agreement between predicted and observed AKI rates across quintiles of risk. Conclusions: This is the first risk calculator to assess post-TAVR risk of AKI. We found that information known pre-procedurally can be used to predict AKI. This may allow for more informed decision-making as well as identifying high-risk patients.
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Zivkovic et al. (2018) conducted an observational in Acute kidney injury after transcatheter aortic valve replacement (n=1,993). Pre-procedural risk score was evaluated on Acute kidney injury (AKI) as defined by the Valve Academic Research Consortium Guidelines (c-statistic 0.713). A six-variable pre-procedural risk score successfully predicted the absolute risk of acute kidney injury after transcatheter aortic valve replacement with good discrimination (c-statistic 0.713).
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