Contrast media volume/eGFR and Syntax score are more valuable marker than anemia, hyperuricemia and hyperglycemia to predict contrast induced nephropathy in patients with emergency coronary procedure

Abstract

Background: Previous reports have demonstrated that the ratio of contrast media volume to the estimated glomerular filtration rate (CMV/eGFR), anemia, hyperuricemia and hyperglycemia could be predictors of contrast induced nephropathy (CIN). The SYNTAX score is a current angiographic tool grading the complexity of coronary artery disease, but there is no information available on the value of the SYNTAX score for the prediction of CIN. We sought to evaluate which of these predictors, including the SYNTAX score, is the most valuable for the prediction of CIN in the emergency clinical setting. Methods: We prospectively enrolled 142 pts who underwent an emergency coronary procedure. CIN was defined as an absolute (≥0.5 mg/dl) or relative (≥25%) increase in serum creatinine level with in 48 hours after the procedure, compared to baseline values. At the entry, hemoglobin (Hb), serum uric acid (UA), creatinine, blood glucose (BS) and HbA1c levels were measured. eGFR was calculated by the MDRD equation. The SYNTAX score was assessed with angiogram before coronary procedure. Results: CIN occurred in 17% (24/142). Patients with CIN had significantly higher BS level (255±239 vs 169±88 g/dl, p=0.04), higher CMV/eGFR (4.81±3.86 vs 2.65±1.81, p=0.0008), and higher SYNTAX score (21±12 vs 15±11, p=0.01) than those without CIN, while there were no significant differences in Hb, UA, or HbA1c levels between them. At multivariate logistic regression analysis, CMV/eGFR (p=0.003, Odds ratio 1.33, 95% CI 1.1 to 1.6) and the SYNTAX score (p=0.03, Odds ratio 1.05, 95% CI 1.003 to 1.097) were independent predictors of CIN. The receiver-operator characteristic analysis indicated that CMV/eGFR of 3.1 (AUC 0.71 (95% CI, 0.60 to 0.82), sensitivity 67%, specificity 69%) and the SYNTAX score of 18 (AUC 0.66 (95% CI, 0.55 to 0.788), sensitivity 57%, specificity 63%) were fair discriminators for CIN. The predictive accuracy for the combination of the CMV/eGFR and SYNTAX score criteria increased (76%), compared with those for the CMV/eGFR (69%) or SYNTAX score criteria (61%, p<0.05). Conclusions: The ratio of CMV to eGFR and the SYNTAX score were significant and independent predictors of CIN in patients with emergency coronary procedure.