Association of random glucose to albumin ratio with post-contrast acute kidney injury and clinical outcomes in patients with ST-elevation myocardial infarction

Abstract

Abstract Background Both glucose and albumin are associated with chronic inflammation, which plays a vital role in post-contrast acute kidney injury (PC-AKI). However, the relationship between the combination of random glucose and albumin in PC-AKI patients remains elusive. Current study aims to explore the relationship between random glucose to albumin ratio (RAR) and the incidence of PC-AKI after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Methods We consecutively enrolled STEMI patients who underwent PCI from January,01 2010 to February,28 2020. All patients were categorized into Q1, Q2, and Q3 groups, respectively, based on RAR value ( RAR<8.62; 8.62≤ RAR ≤ 9 .04; 9.04≤ RAR ≤ 9.45). The primary outcome was the incidence of PC-AKI, which is defined as an increase in serum creatinine (SCr) of more than 44.2 mol/L (0.5 mg/dL) from baseline during the inital 48 to 72 hours after contrast exposure. The incidence of major adverse clinical events (MACE) was the second endpoint, which included all-cause mortality, recurrent of myocardial infarction, renal replacement therapy, stroke, and revascularization of target vessel during hospitalization. The association between RAR and PC-AKI was assessed by multivariate logistic regression analysis. Results A total of 2924 patients with STEMI were finally included. The incidence of PC-AKI increased in a stepwise manner with the increasing tertile of RAR (3.2% vs 4.8% vs 10.6%, P<0.001). Multivariate regression analyses demonstrated that RAR(as a continuous variable) was associated with the incidence of PC-AKI (adjusted odds ratio (OR) =1.10, 95% confdence interval (CI) =1.04–1.16, P=0.000) and in-hospital MACE (OR=1.07, 95% CI=1.02–1.14, P=0.012); When RAR was a categorical variable, RAR was related to PC-AKI (Q3 vs. Q1, OR=1.70, 95% CI=1.08–2.67, P=0.021), and in-hospital MACE (Q3 vs. Q1, OR=1.63, 95% CI=1.02-2.60, P=0.041) when analyzed by multivariate regression analyses. Receiver operating characteristic curve analysis showed that RAR exhibited a predictive value for PC-AKI(area under the curve (AUC)=0.666, 95% CI=0.625-0.708, P<0.001), and in-hospital MACE (AUC= 0.662, 95% CI =0.619 - 0.706) . In addition, the AUC of RAR for predicting PC-AKI in the no diabetes subgroup was significantly higher compared to that in the diabetes subgroup (AUC: 0.640 vs. 0.611, P=0.021). Conclusions The high value of RAR was significantly associated with the incidence of PC-AKI and in-hospital MACE after PCI in STEMI patients, and RAR offers a robust predictive value for these outcomes.Figure 1Figure 2