Mehran et al developed a simple score for predicting nephropathy associated with radiocontrast material used during a percutaneous coronary intervention. This can help identify a patient at risk for renal dysfunction and who may benefit from more aggressive management. The authors are from Columbia University Medical Center in New York City.
Parameters:
(1) hypotension
(2) intra-aortic balloon pump (IABP)
(3) congestive heart failure
(4) age of the patient in years
(5) anemia
(6) diabetes mellitus
(7) volume of contrast media used
(8) estimated GFR (or serum creatinine)
estimated GFR in mL per minute per 1.73 square meter BSA =
= 186 * ((serum creatinine in mg/dL)^(-1.154)) * ((age in years)^(-0.203)) * (points for gender) * (points for race)
where:
• Points for gender: 1 if male, 0.742 if female
• Points for race: 1 if non-Black, 1.21 if Black)
|
Parameter |
Finding |
Points |
|---|---|---|
|
hypotension |
absent |
0 |
|
|
present |
5 |
|
IABP |
not used |
0 |
|
|
deployed |
5 |
|
congestive heart failure |
absent |
0 |
|
|
NYHA Class I or II |
0 |
|
|
NYHA Class III or IV |
5 |
|
|
history of pulmonary edema |
5 |
|
age of the patient |
<= 75 years of age |
0 |
|
|
> 75 years of age |
4 |
|
anemia |
absent |
0 |
|
|
male and hematocrit < 39% |
3 |
|
|
female and hematocrit < 36% |
3 |
|
diabetes mellitus |
absent |
0 |
|
|
present |
3 |
|
volume of contrast media |
|
ROUND((volume in mL) / 100) |
|
|
|
|
|
estimated GFR |
> 60 mL per min per 1.73 square meters |
0 |
|
|
40 - 60 |
2 |
|
|
20 - 40 |
4 |
|
|
< 20 |
6 |
where:
• Hypotension is systolic blood pressure < 80 min Hg for > 1 hour requiring inotropic support or an intra-aortic balloon pump within 24 hours after the procedure.
• If the serum creatinine is used instead of the estimated GFR, then a serum creatinine > 1.5 mg/dL is scored as 4 points, else 0.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: >= 32 (depends on volume of contrast media used)
|
Total Score |
Risk Group |
Percent with Nephropathy |
Percent Requiring Dialysis |
|---|---|---|---|
|
0 to 5 |
low |
8% |
rare |
|
6 to 10 |
moderate |
14% |
0.1% |
|
11 to 15 |
high |
26% |
1% |
|
16 to 32+ |
very high |
57% |
13% |
Purpose: To evaluate a patient for the risk of radiocontrast-induced nephropathy after a percutaneous coronary intervention using the score of Mehran et al.
Specialty: Hematology Oncology, Pharmacology, clinical
Objective: risk factors, adverse effects
ICD-10: N17, T82,
