Mehran Score 2004 and 2021 for prediction of risk of contrast induced AKI

Mehran Score 2004 and 2021 for prediction of risk of contrast induced AKI

The initial Mehran score for prediction of risk of contrast induced acute kidney injury in patients undergoing percutaneous coronary intervention was published by Roxana Mehran and associates in 2004 [1]. They randomized data of over eight thousand three hundred patients to development and validation data sets. Clinical and procedural data from over five thousand five hundred were considered for univariate predictors of contrast induced acute kidney injury.

Eight variables considered in the Mehran score 2004 were:

1. Hypotension
2. Intra aortic balloon pump usage
3. Congestive heart failure
4. Chronic kidney disease
5. Diabetes
6. Age above seventy five years
7. Anemia
8. Volume of contrast

A weighted integer was assigned to each and total score was the risk score for each patient. It was classified as:

1. Low risk: Score of 5 or less
2. Moderate risk: Score 6-10
3. High risk: Score 11-15
4. Very high risk: Score of 16

A revised score has been published by Roxana Mehran et al in 2021, which had two models. While Model 1 included only pre-procedural variables, Model 2 included procedural variables as well. The study had 14,616 patients in the derivation cohort and 5606 patients in the validation cohort. Variables in the Model 1 were clinical presentation, estimated glomerular filtration rate, left ventricular ejection fraction, diabetes, haemoglobin, basal glucose, congestive heart failure, and age.

Model 2 had additional predictors as contrast volume, peri-procedural bleeding, no flow or slow flow post procedure, and complex PCI anatomy. Contrast associated AKI increased gradually from the lowest to highest in the four risk score groups in both models. They found that inclusion of procedural variables in the model improved the discrimination of the risk score only slightly.

References

1. Roxana Mehran, Eve D Aymong, Eugenia Nikolsky, Zoran Lasic, Ioannis Iakovou, Martin Fahy, Gary S Mintz, Alexandra J Lansky, Jeffrey W Moses, Gregg W Stone, Martin B Leon, George Dangas. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004 Oct 6;44(7):1393-9.
2. Mehran R, Owen R, Chiarito M, Baber U, Sartori S, Cao D, Nicolas J, Pivato CA, Nardin M, Krishnan P, Kini A, Sharma S, Pocock S, Dangas G. A contemporary simple risk score for prediction of contrast-associated acute kidney injury after percutaneous coronary intervention: derivation and validation from an observational registry. Lancet. 2021 Nov 27;398(10315):1974-1983. doi: 10.1016/S0140-6736(21)02326-6. Epub 2021 Nov 15. PMID: 34793743.