RT Journal Article
SR Electronic
T1 A 5-Item Prediction Rule to Identify Severe Renal Dysfunction in Patients with Acute Stroke
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1449
OP 1454
DO 10.3174/ajnr.A3013
VO 33
IS 8
A1 M.D.I. Vergouwen
A1 J. Fang
A1 L.K. Casaubon
A1 M.K. Kapral
A1 M. Stamplecoski
A1 A. Robertson
A1 F.L. Silver
YR 2012
UL http://www.ajnr.org/content/33/8/1449.abstract
AB BACKGROUND AND PURPOSE: Although patients with severe renal dysfunction who receive iodinated contrast are at high risk of CIN, contrast-enhanced CT scans are often obtained without prior knowledge of kidney function in patients with acute stroke. We aimed to develop a tool to identify patients with acute stroke at a high risk of CIN in the absence of a recent GFR. MATERIALS AND METHODS: We used the RCSN (9872 patients) and OSA (2544 patients) for our derivation and validation cohort, respectively. A multivariable logistic regression model was performed to develop a predictive tool to identify severe renal dysfunction (defined as a GFR < 30 mL/min/1.73 m2). RESULTS: The overall prevalence of severe renal dysfunction was 4.9% and 5.2% in the derivation and validation cohort, respectively. The prediction rule was designed as follows: (age in years) + (5 points for women) + (5 points for history of diabetes mellitus) + (15 points for preadmission insulin use) + (10 points for history of hypertension). The prevalence of severe renal dysfunction is negligible in patients with a total score of ≤70 (≤0.005%–0.7%) but increases with higher Renal Risk Scores (eg, scores 71–80: 2.1%–2.2%; scores 91–100: 6.6%–7.1%; scores 111–120: 15.9%–28.1%). CONCLUSIONS: The Renal Risk Score is a validated tool that helps clinicians select which patients with stroke can safely proceed to contrast-enhanced brain imaging without waiting for laboratory evidence of good renal function. CIconfidence intervalCINcontrast-induced nephropathyCKD-EPIChronic Kidney Disease Epidemiology CollaborationGFRglomerular filtration rateIQRinterquartile rangeORodds ratioOSAOntario Stroke AuditRCSNRegistry of the Canadian Stroke Network