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Comparison of Tziakas Risk Score vs. Mehran Risk Stratification in predicting contrast-Induced acute kidney injury among patients undergoing coronary angiography or percutaneous coronary intervention at St. Luke’s Medical Center – Quezon City

Federick Cheng, Frederick Ogbac. MD, Leah Gonzales-Porciuncula. MD, Michelle Jane Buaron. MD, Russel Semeniano. MD, Oscar Naidas. MD

Background: Contrast-induced acute kidney injury (CI-AKI) occurs after the administration of iodinated contrast media and has become one of the leading causes of hospital acquired acute kidney injury. Clinical risk prediction scoring systems for developing CI-AKI have been developed to stratify the risk of patients undergoing PCI. The risk prediction scoring that is currently being utilized at St. Luke’s Medical Center – QC (SLMC-QC) is the Mehran Risk Stratification. However, the Tziakas Risk Score is a new risk stratification model that offers several advantages including application to emergency cases and inclusion of pre-exising co-morbidities and medications into the model. This study aims to compare Tziakas Risk Score versus Mehran Risk Stratification in predicting CI-AKI among patients who will undergo coronary angiography or PCI at SLMC-QC.

Methods: Patients who underwent coronary angiography or PCI were identified from the census of the Cardiac Catheterization Laboratory of St Luke’s Medical Center – Quezon City starting January 2012 until September 2014. The medical records of the identified patients were reviewed for possible inclusion to the study. Tziakas Risk Score and Mehran Risk Stratification were analyzed for sensitivity, specificity, predictive values, likelihood ratio, overall accuracy and Receiver’s Operating Curve (ROC).

Results: A total of 414 patients were included for analysis. CI-AKI occurred in 55 out of 414 (13.28%) of the study population. Fifteen out of 414 (3.62%) of the patients required hemodialysis after the procedure. Tziakas Risk Score had 43.6% sensitivity, 90.8% specificity, 42.1% PPV and 91.3% NPV, while Mehran Risk Stratification had 32.7% sensitivity, 89.1% specificity, 89.6% PPV and 81.6% NPV. There was no statistical significance between the ROCs of the two risk stratification models.

Conclusion: In patients who will undergo PCI, Tziakas Risk Score has a better predictive value compared to Mehran Risk Stratification. Further prospective and multicenter studies comapring the two risk models is recommended to substantiate its broad applicability in centers with different clinical practices.