Contrast-Associated Acute Kidney Injury After Thrombectomy for Ischemic Stroke: Prognostic Impact and CAN-REST Predictive Score.
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Schwarz Ghil, Cascio Rizzo Angelo, Ambler Gareth, Wrona Pawel, Slowik Agnieszka, Kotas Szymonn, Doheim Mohamed F, Al-Bayati Alhamza R, Nogueira Raul G, Nunes Ana Paiva, Ferreira Patricia, Paolucci Matteo, Zini Andrea, Simonetti Luigi, Leško Norbert, Fedorko Jakub, Gdovinova Zuzana, Scarcia Luca, Kalsoum Erwah, Farhat Firas, Beyeler Morin, Mujanovic Adnan, Arnold Marcel, Meira Torcato, Morais Marta, Francisco Leonor, Wiacek Marcin, Pudło Paulina, Bartosik-Psujek Halina, Calleja Patricia, Ostos Fernando, Seoane David, Negrila Anca, Radu Razvan Alexandru, Tiu Cristina, Al Kasab Sami, Qdais Ahmad Abu, Samman Tahhan Imad, Ayo-Martin Oscar, Paya Maria, Molina-Nuevo Juan David, Labuz-Roszak Beata, Toni Danilo, Moszko Karolina, Roszak Mateusz Łukasz, De Michele Manuela, Barrile Elena, Eswaradass Prasanna, Houghton Margaret, Barkley Tiffany, Ali Amir, Demeestere Jelle, Bauknight Wayne Martin, Sheth Sunil, Maes Louise, Wouters Anke, Pedro Marto João, Blazer Costa Josè, Loizzo Nicola D, Romi Andrea, Currò Carmelo Tiberio, Luchowski Piotr, Seweryn Maksymilian, Rejdak Konrad, Klein Piers, Abdalkader Mohamad, Saia Valentina, Sanna Antioco, Tassinari Tiziana, Acampa Maurizio, Rosini Francesca, Tassi Rossana, Bilik Marta, Bandzarewicz-Samcik Anna Maria, Min Jiangyong, HajAissa Naser, Mangiardi Marilena, Anticoli Sabrina, Pampana Enrico, Hervás-Testal Carlos, Rigual Ricardo, Fuentes Blanca, Strambo Davide, Tetaria Carl Manuata, Saliou Guillaume, Caramma Andrea Salvatore, Maimone Davide, Rizzo Pier Andrea, Moci Marco, Scala Irene, Cruz-Culebras Antonio, Vera Lechuga Rocío, García-Madrona Sebastián, Merlino Giovanni, Valente Mariarosaria, Cella Arianna, Bolognese Manuel, Lakatos Lehel-Barna, Karwacki Grzegorz M, Candelaresi Paolo, Andreone Vincenzo, Maurea Carlo, Tarletti Roberto, Mele Angelica, Ciacciarelli Antonio, Alessiani Michele, Monteforte Gabriella, Pakizer David, Roubec Martin, Školoudík David, Vandervorst Fenne, De Raedt Sylvie, Verdam Martijn, Bartoš Josef, Sramek Martin, Mazzoleni Valentina, Quilici Luca, Alimonti Dario, Moller Jessica, Maestrini Ilaria, Diomedi Marina, Lacidogna Giordano, Zaidat Osama O, Lin Eugene, Almajali Mohammad, Baracchini Claudio, Zaccagnino Matteo, Viaro Federica, Pezzini Alessandro, Avola Giulia, Ferraro Chiara, Świtońska Milena, Sobieszak-Skura Paulina, Meder Grzegorz, Mayer-Suess Lukas, Knoflach Michael, Gizewski Elke R, Common Matthew R, Nicholson Patrick, Power Sarah, Nowakowska-Kotas Marta, Puła Michal, Guzinski Maciej, Pérez-Sánchez Soledad, Montaner Joan, Bravo Alexandra Sevilla, Marcheselli Simona, Vodret Francesca, Rapillo Costanza Maria, Pereira Liliana, Rodrigues Miguel, Jaros Adam, Kovar Martin, Vojik Jan, Valcamonica Gloria, Cassarino Serena Gallo, Cardillo Alessandra, Petruzzellis Marco, Grimaldi Silvia, Marrone Nicola, Hassan Ameer E, Miller Samantha, Khasawneh Mohammad W, Poretto Valentina, Tonello Simone, Tollot Saverio, DęBiec Aleksander, Staszewski Jacek, Stepien Adam, Bernardo Francisco, Ferrao Jorge, Zedde Marialuisa, Pascarella Rosario, Sanna Alessandra, Meloni Rossella, Delibas Sennur, Sacco Simona, Vittorini Maria Grazia, Ornello Raffaele, Mannino Marina, Terruso Valeria, Filizzolo Marco, Hall Emily, Roffe Christine, Dorobek Malgorzata, Zielińska-Turek Justyna, Scopelliti Giuseppe, Pantoni Leonardo, Pero Guglielmo C, Macera Antonio, Cervo Amedeo, Bellavia Simone, Sezgin Mine, Dilmen Yavuz, Ekizoglu Esme, Tsivgoulis Georgios, Theodorou Aikaterini, Tiu Vlad, Panea Cristina Aura, Petrescu Simona, Piano Mariangela, Nguyen Thanh N, Sessa Maria, as the CAN-REST Study Group
Аннотация
METHODS: A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates.
RESULTS: Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances.
DISCUSSION: In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.