Development Of Contrast-induced Nephropathy Research Articles

Evaluation of contrast induced nephropathy related risk factors and long-term results.

We aimed to evaluate the frequency of contrast induced nephropathy (CIN), its relationship with accepted risk factors and long-term renal outcomes in patients who underwent coronary angiography (CAG). All patients who underwent CAG between April 2020 and April 2021 were retrospectively evaluated. CIN was defined as characteristic increase in serum creatinine after CAG. CIN developed in 50 (5.4%) of 934 patients. The CIN rate was found to be statistically significantly higher in patients with diabetes, hypertension, heart failure and those using diuretics. Pre-procedural hemoglobin, albumin and GFR were found to be independent risk factors for CIN. After discharge, the urea and creatinine values of the patients who developed CIN were significantly higher than those who did not. We concluded that in order to reduce the development of CIN, hemoglobin and albumin levels should be evaluated with renal functions before the procedure and they should be kept within normal limits.

The Association and Utility of Left Ventricular End-Diastolic Pressure in Predicting the Development of and in Managing Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography.

Contrast-induced nephropathy (CIN) is a significant complication in patients undergoing coronary angiography, and its development is associated with increased morbidity and mortality. Left ventricular end-diastolic pressure (LVEDP) provides one index of left heart filling status. An elevated LVEDP can reflect volume overload or abnormal diastolic function and indicates a cardiac disorder. Data on the association between an elevated LVEDP and CIN are limited and have had conflicting results. We systematically searched the databases PubMed, Embase, and Scopus for full-text articles from database inception to May 2022. Studies were included if they evaluated the association between a high LVEDP and the incidence of CIN in patients undergoing coronary angiography. The study was registered in the PROSPERO CRD42022334070. A second search in PubMed identified randomized controlled trials using LVEDP to guide fluid administration during coronary procedures. Four studies were identified that used LVEDP to classify patients into groups to determine the association between the level and the development of CIN. In these studies, 240 patients of 2441 patients (9.8%) developed CIN. One study found no association between LVEDP levels and the development of CIN. Two studies found an increased frequency of CIN in patients with elevated levels using 2 cutoff points for LVEDP, ≥20 mm Hg and >30 mm Hg. One study found that lower LVEDP levels (5-14 mm Hg) were associated with the development of CIN. Three randomized control trials used LVDEP levels to manage fluid administration in patients undergoing coronary procedures; only one study found that the use of these levels to guide fluid administration resulted in better outcomes. In patients undergoing coronary angiography, an elevated LVEDP was not consistently associated with increased risk of CIN, and using LVEDP levels to guide fluid administration during these procedures did not always improve outcomes in comparison to other protocols. The use of LVEDP levels can help classify patients with cardiac disorders but does not necessarily provide an adequate description of the hemodynamic patterns in these patients to predict or prevent CIN in patients undergoing angiography.

Does metabolic syndrome increase contrast-induced nephropathy in patients with normal renal function?

Contrast-induced nephropathy (CIN) is associated with increased mortality and morbidity in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention. This study aimed to compare the incidence of CIN in two groups of patients with and without metabolic syndrome (Mets) with baseline normal renal function. In this case - control study, 260 patient candidates for CAG, 130 patients with Mets and 130 patients without Mets participated, and their serum creatinine (Cr) level before and the 48 and 72 h after the angiography was measured. The incidence of CIN was compared in two groups. Two-way analysis of variance with repeated measures and univariate and multivariate logistic regression models. The results showed a higher chance of being Mets with raising in triglyceride (adjusted odds ratio = 1.05, 95% confidence interval = (1.03-1.06), P < 0.001), Fasting blood glucose (1.010 [1.001-1.019], P = 0.025), and diastolic blood pressure (1.07 [1.07-1.20], P < 0.001), but declining in high-density lipoprotein-cholesterol (HDL-C) (0.91 [0.85-0.98], P = 0.008). Furthermore, blood urea nitrogen (BUN) and Cr level was raised in 48 and 72 h after contrast injection in both groups (All P < 0.001). Furthermore, in 48 h (3.11 [1.12-9.93], P = 0.016) and 72 h (2.82 [1.07-8.28], P = 0.021) after injection, a total of 25 patients had an increased Cr level and a significant difference between Mets and without Mets groups. The developing Mets had a significant association with the increased risk of AKI, which increased the chance of developing nephropathy (7.14 [2.27-22.5], P = 0.001). Mets, together with other risk factors, increased the overall risk of CIN development. Therefore, the incidence of CIN in patients Mets is significantly higher than that of patients without Mets, indicating a more important CIN risk factor.

Comparing two risk scores for predictive ability of contrast-induced nephropathy development in patients presenting with chronic coronary syndrome

Comparing two risk scores for predictive ability of contrast-induced nephropathy development in patients presenting with chronic coronary syndrome

CONTRAST-INDUCED NEPHROPATHY IN POST-COVID-19 PATIENTS

Abstract. Introduction. Contrast-induced nephropathy is a serious cause of acute kidney injury and represents an urgent problem in clinical practice. Until recently, there are contradictions in the understanding of many aspects of contrast-induced nephropathy. However, the current situation with using CAs in patients with COVID-19, thus causing contrast-induced nephropathy, has become an urgent issue for clinical physicians and radiologists. Aim of this study is to review some up-to-date information on the use of newer and less nephrotoxic drugs among post-COVID-19 patients with a previous renal impairment. Material and Methods. Topical studies published on studying contrast- induced nephropathies in post-COVID-19 patients have been reviewed herein. Results and Discussion. In case of developing the acute renal failure syndrome caused by using CAs in past-COVID-19 patients, first it is necessary to exclude alternative (non-contrast-induced) causes of its occurrence, such as thromboembolism syndrome that may develop upon angiography, ischemic nephropathy, nephrotoxic effects. Upon administration of the X-ray ca, a short-term increase in creatinine levels is possible after 24 hours, but this does not mean the development of contrast-induced nephropathy. Conclusions. To prevent the development of contrast-induced nephropathies, patients must be adequately hydrated. Nephrotoxic drugs should be discontinued at least 24 hours before ca administration. Moreover, the choice of a suitable ca is important.

The Role of Pan-Immune-Inflammation Value in Predicting Contrast-Induced Nephropathy Development in Patients Undergoing Percutaneous Coronary Intervention Due to NSTEMI.

Contrast-induced nephropathy (CIN), which can develop after procedures involving contrast agents, is a significant cause of patient morbidity and mortality. This study aims to investigate the role of pre-procedural pan-immune-inflammation value (PIV) in predicting CIN development in patients undergoing percutaneous coronary intervention (PCI) due to non-ST segment elevation myocardial infarction (NSTEMI). A total of 1006 NSTEMI patients were included in the study. CIN was defined as an increase of at least 0.5mg/dl or 25% in serum baseline creatinine level 72h after the procedure. Patients were divided into two groups: those with and without CIN. NSTEMI patients who developed CIN, glucose level (P = .01), platelet count (P < .01), monocyte count (P < .001), neutrophil-to-lymphocyte ratio (NLR) (P < .001), systemic immune inflammation index (SII) score (P < .001), and PIV (P < .001) were higher compared with those without CIN. In the multivariate analysis of all these parameters, the Odds ratios of PIV and SII were similar and slightly lower than NLR. Receiver operating characteristic curve analysis (ROC) showed a PIV cut-off value of 448.43 with a sensitivity of 83.1% and a specificity of 72.8% in patients with CIN. Our study demonstrated an independent relationship between PIV at admission and CIN development in NSTEMI patients.

A Simple Strategy to Reduce Contrast Media Use and Risk of Contrast-Induced Renal Injury during PCI: Introduction of an "Optimal Contrast Volume Protocol" to Daily Clinical Practice.

Contrast-induced acute kidney injury is the leading cause of iatrogenic acute nephropathy. Development of contrast-induced nephropathy (CIN) increases the risk of adverse long- and short-term patients outcomes, the hospital costs, and length of hospitalization. There are a couple of methods described for CIN prevention (statin prescription, prehydration, contrast media (CM) clearance from the blood system, and decrease amounts of contrast volume). The CM volume to patient's creatinine clearance ratio is the main factor to predict the risk of CIN development. The safe CM to creatinine clearance ratio limits have been established. The usage of CM amount depends on personal operators habits and inside center regulations. There is no standardized contrast usage protocol worldwide. The aim of this study was to establish an easy to use, cheap, and efficient protocol to estimate a personalized safe CM dose limit for every patient based on their kidney function. These limits are announced during the "Time Out" before the procedure. Our study included 519 patients undergoing interventional coronary procedures: 207 patients into the "Optimal Contrast Volume" arm and 312 into the control group. Applying the protocol into a daily clinical practice leads to a significant reduction in CM volume used for all type of procedures and the development of CIN in comparison with a control group.

The PRECISE-DAPT Score as a Predictor of Constrast Induced Nephropathy in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Abstract Background In the ACS population, there are inherent difficulties in rapidly assessing CIN risk and instigating prophylactic measures. Moreover, these procedures often use increased contrast volume and the patients are more likely to be haemodynamically compromised, increasing their risk of renal impairment. This was a prospective observational cohort study conducted on 200 patients with acute coronary syndrome (ACS), and undergoing percutaneous coronary intervention (PCI); to evaluate the predictive value of PRECISE DAPT score for the development of contrast induced nephropathy (CIN). Aim of the Work To evaluate the predictive value of PRECISE DAPT score for the development of CIN in ACS patients undergoing PCI, and compare its predictive power to Mehran score, and to contrast volume/eGFR ratio. Patients and Methods A total of 200 patients who were diagnosed with ACS and undergoing PCI, were recruited from Ain Shams University Hospitals and enrolled in the study. The primary endpoint was the development of CIN after PCI. CIN defined as an increase of &amp;gt; 25%, and/or &amp;gt; 0.5 mg/dl in serum creatinine at 3-5 days after PCI when compared to baseline value. Results The median age of all patients was (55) years, the majority (74.5%) of patients were males; while (25.5%) were females; (6.5%) of patients had positive family history of CAD, (35.5%) had DM, (42%) had HTN, (18.5%) had Dyslipidemia, (10%) had history of anemia, and (10.5%) had previous indexed MI The median Contrast volume was 180 ml, the median duration of procedure was (50 min). LAD was the culprit artery in (65.5%) of cases, RCA in (21.5%) of cases, LCX in (13 %) of cases. (10.5%) of patients suffered post procedural CIN (n = 21), (3%) of patients had No reflow, (4.5%) had Major bleeding, (27.5%) had Minor bleeding, and (25%) had Acute Heart Failure. The average Mehran score was 5 (range from 1 to 28), the average PRECISE DAPT score was 18(range from 2 to 60), PRECISE-DAPT score showed excellent predictive value for CIN development (AUC = 0.91, 95% CI = 0.86 to 0.94, P &amp;lt; 0.0001). Best cut-off is score &amp;gt;27 (sensitivity = 85.7%, 95% CI = 63.7% - 97.0%, specificity = 87.7%, 95% CI = 82.0% - 92.1%; Jindex = 0.73). PRECISE-DAPT was superior to both Mehran score (ΔAUC = 0.12, P = 0.018) and CV/eGFR (ΔAUC = 0.19, 95%, P = 0.018). There was no statistically significant difference between Mehran and CV/eGFR. (ΔAUC = 0.07, P = 0.304). Conclusion PRECISE-DAPT score showed excellent predictive value in predicting the development of (CIN) in ACS population, AUC = 0.91 (P &amp;lt; 0.0001). Best cut-off is score &amp;gt; 27 (sensitivity = 85.7%, specificity = 87.7%), exceeding Mehran score and CV/eGFR ratio. Validation of Mehran score in ACS was achieved. It showed good predictive value, AUC = 0.79 (P &amp;lt; 0.0001). Best cut-off is Mehran score &amp;gt; 6 (sensitivity = 81.0%, specificity = 67.6%). There is no statistically significant difference between Mehran and CV/eGFR. Logistic regression analysis showed that; serum creatinine level pre-PCI, wall motion score index, LAD infarction, and PRECISE DAPT score; all had an independent effect on increasing the probability of CIN occurrence; with significant statistical difference (p &amp;lt; 0.05 for all). Abbreviations ACEI: Angiotensin-converting enzyme inhibitor; ACS: Acute coronary syndrome; AHA: American Heart Association; AKI: Acute kidney injury; AMI: Acute myocardial infarction; CI-AKI: Contrast-induced acute kidney injury; CIN: Contrast-induced nephropathy; CK-MB: Creatine kinase myocardial band; CM: Contrast media; CV/GFR: Contrast Volume/eGFR Ratio: Estimated Glomerular Filtration Rate.; DBP: Diastolic blood pressure; DM: Diabetes mellitus; EF: Ejection fraction; Gp: Glycoprotein; Hb: Hemoglobin; HOCM: High osmolar contrast media; IABP: Intra-aortic balloon; IQR: Inter-quartile range; LAD: Left anterior descending artery; LCX: Left circumflex coronary; MAP: Mean arterial blood pressure. MI: myocardial infarction.; MBG: Myocardial blush grade; MINOCA: Myocardial infarction in the absence of obstructive coronary artery disease; NSTEMI: Non-ST elevation myocardial infarction; PCI: Percutaneous coronary intervention; PLT: Platelets; RCA: Right coronary artery; ROC curve: Receiver operating characteristic analysis; SD: Standard deviation; STEMI: ST-segment elevation myocardial infarction; SYNTAX: Synergy Between PCI With Taxus and Cardiac Surgery; TIMI: Thrombolysis in Myocardial Infarction; TLC: Total leucocytic count

The association between hemogram parameters and the development of contrast-induced nephropathy in patients presenting with non-ST-elevation myocardial infarction

Abstract Objectives Hemogram parameters such as mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLr), red cell distribution width and platelet distribution width are widely used inflammatory indicators to assess prognosis in various cardiovascular diseases. In this study, we aimed to investigate the role of hemogram parameters to predict the development of contrast-induced nephropathy (CIN) in patients presenting with non-ST segment elevation myocardial infarction (non-STEMI) and treated with percutaneous coronary intervention (PCI). Methods All pateints who underwent PCI with a diagnosis of non-STEMI between 2017 and 2020 in our center were included retrospectively in this study. Results A total of 387 patients were included in this retrospective study. Advanced age (p=0.001, β:0.005, OR [95 % CI]: 0.002–0.007), diabetes mellitus (p=0.013, β:0.205, OR [95 % CI]: 0.150–0.260), congestive heart failure (p=0.009, β:0.095, OR [95 % CI]: 0.024–0.166), volume of contrast medium (p=0.008, β:0.241, OR [95 % CI]: 0.184–0.392), MPV (p=0.02, β:0.047, OR [95 % CI]: 0.028–0.065) and NLr (p=0.001, β:0.052, OR [95 % CI]: 0.040–0.063) were found as independent risk factors associated with CIN development according to multivariate logistic regression analysis. A cut off value of 5.5 for NLr was associated with 79.6 % sensitivity and 79.5 % specificity and 9.05 for MPV was associated with 64.1 % sensitivity and 58.7 % specificity in prediction of CIN development. Conclusions Hematological parameters, assessed by routine blood count analysis may serve as a promising and useful marker for CIN especially when used in combination with traditional risk factors. MPV and NLr were demonstrated as predictors of CIN development in non-STEMI patients who were treated with PCI in our study.

Development and Validation of Nomogram Based on the Systemic-Immune Inflammation Response Index for Predicting Contrast-Induced Nephropathy in ST-Elevation Myocardial Infarction Patients.

Contrast-induced nephropathy (CIN) is a prominent complication of ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (pPCI). The systemic immune inflammation response index (SIIRI) is a novel inflammatory marker developed by multiplying the monocyte count by the systemic immune inflammation index (SII) and is associated with coronary artery disease severity. We investigated the predictive ability of SIIRI for detecting CIN in STEMI patients (n = 2289) following pPCI and developed a nomogram based on SIIRI for risk stratifying. CIN was diagnosed based on an elevation in baseline creatinine levels >.5mg/dL or 25% within 72h after pPCI; 219 CIN (+) and 2070 CIN (-) patients were included. CIN (+) patients had higher SIIRI than CIN (-) patients and SIIRI was an independent predictor of CIN. A nomogram based on SIIRI had good calibration and discrimination abilities for predicting CIN development. SIIRI was superior to SII in discriminating CIN (+) patients. Adding SIIRI to the baseline model, which consists of age, hypertension, hemoglobin, estimated glomerular filtration rate, albumin, ejection fraction, lesion length, and pain-to-balloon time, had a higher discriminative ability and benefit in detecting CIN (+) patients than baseline model as assessed by decision curve analysis.

Carbon Dioxide Guided Endovascular Aortic Aneurysm Repair in Impaired Renal Function: Propensity Score Matched Study

Carbon dioxide (CO2) is the preferred contrast agent in patients with impaired renal function and or contrast allergy and, particularly, in patients who require large volumes of contrast for complex endovascular procedures. In this study, the aim was to clarify the possible protective effects of CO2 guided endovascular aneurysm repair (EVAR) for patients with impaired renal function by propensity score matching. A retrospective analysis of the database was performed for 324 patients having EVAR between January 2019 and January 2022. A total of 34 patients treated with CO2 guided EVAR were evaluated. This cohort was matched for age, sex, pre-operative serum creatinine levels and glomerular filtration rate (GFR) levels and specific comorbidities to obtain homogeneous groups that included only patients with impaired renal function (eGFR < 60 mL/min/1.73m2). The primary endpoint was to compare the decrease in eGFR from baseline and development of contrast induced nephropathy (CIN) using propensity score matching. Secondary endpoints were the need for renal replacement therapy, other peri-procedural morbidity and mortality. Thirty-one patients (9.6%) of the total population developed CIN. There was no difference in the rate of CIN development between the standard EVAR group and the CO2 guided EVAR group in the unmatched population (10% vs. 3%, p= .15). After matching, the decrease in eGFR values after the procedure was more pronounced for the standard EVAR group (from 44 to 40 mL/min/1.73m2, interaction p= .034). Meanwhile, CIN development was more frequent for the standard EVAR group (24% vs. 3%, p= .027). In matched patients, early death did not differ between the groups (5.9% vs. 0, p= .15) CONCLUSION: Patients with impaired renal function are at higher risk of CIN after an endovascular procedure. CO2 guided EVAR is a safe, effective, and feasible treatment option, especially for patients with impaired renal function. CO2 guided EVAR may be a protective measure for contrast induced nephropathy.

A new indicator of contrast-induced nephropathy in patients undergoing elective coronary angiography: tissue doppler-derived E/(EA × SA) index.

Hemodynamic instability plays an important role in the development of contrast-induced nephropathy (CIN), which is an important complication of coronary angiography. Left ventricular (LV) end-diastolic pressure (LVEDP) accurately reflects hemodynamic changes. In clinical practice, measuring LVEDP invasively presents some challenges and is not always accessible. This study aimed to investigate the relationship between tissue Doppler-derived early diastolic conduction velocity (E)/[early mitral annular diastolic velocity (Ea), × peak systolic annular velocity (Sa)] index, an important surrogate for LVEDP, and CIN in patients undergoing elective coronary angiography (ECA). This retrospective study included 388 consecutive patients undergoing ECA. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to baseline values within 72 hours after ECA. Mehran score was calculated in all patients and systolic and diastolic functions were evaluated with Doppler echocardiography. The incidence of CIN was 9.7%. There was a positive correlation between LV EDP levels and LV E/(Ea × Sa) index (r = 0.691, p < 0.001). Higher LV E/(Ea × Sa) index (OR = 1.03, p < 0.001) and Mehran score (OR = 1.41, p < 0.001) were independent predictors of CIN. The threshold value of LV E/(Ea × Sa) index in predicting CIN was > 1.71 with 75.7% sensitivity and 84.3% specificity (AUC = 0.825). In patients undergoing ECA, the non-invasively measured E/(Ea × Sa) index can be used as a risk indicator for CIN.

Red cell distribution width is an inflammatory predictor marker of contrast induced nephropathy in patients undergoing percutaneous coronary intervention

Red blood cell distribution width (RDW) is an inflammatory biomarker reported in complete blood cell (CBC) counts. High RDW defines a proinflammatory state. Contrast-induced nephropathy (CIN) is an important and common complication in percutaneous coronary intervention (PCI) treated patients. The current study was conducted to evaluate the role of RDW as a simple predictive inflammatory marker of CIN in PCI treated patients. The current prospective study enrolled 126 PCI treated patients. Laboratory investigations included CBC, liver function test, (HbA1C), lipid profile and serological tests. Serum urea and creatinine levels were obtained at baseline and 48 to 72 hours after PCI procedure, used to categorize for CIN. Diabetes mellitus, hypertension, and ischemic heart disease were present in 39 (31%), 44 (34.9%), and 23 (18.3%) patients, respectively. Of the studied patients, only 19 (15.1%) patients developed CIN. The hemoglobin level was significantly higher in the non-CIN group (13.49 ± 1.63 vs. CIN group 12.56 ± 1.62 mg/dl; p= 0.02). RDW was significantly higher among CIN group than non-CIN group (16.20 ± 2.60 vs. 13.83 ± 2.19 % (p&lt; 0.001). Delta creatinine (% change in creatinine level after 48 hour) was significantly higher in patients with CIN (59.17 ± 28.89 vs. non-CIN 33.62 ± 9.76; p&lt; 0.001). Predictors for CIN in patients who underwent PCI were old age high RDW high delta creatinine and amount of dye. At cut off &gt; 14.5%, RDW had 79% sensitivity, 70% specificity and 71.3% overall accuracy at AUC of 0.76. In conclusion, RDW may be simple and immediately available inflammatory biomarker and predictor for development of CIN in patients undergoing PCI.

Increased triglyceride-glucose index predicts contrast-induced nephropathy in non-diabetic NSTEMI patients: A prospective study.

The triglyceride-glucose (TyG) index is a new reliable marker of insulin resistance (IR) and has recently been reported to be associated with renal dysfunction and contrast-induced nephropathy (CIN). Our aim in this study is to investigate the relationship between the TyG index and CIN in non-diabetic non-ST elevation acute myocardial infarction (NSTEMI) patients. The study included 272 non-diabetic patients who applied with NSTEMI and underwent coronary angiography (CAG). Patient data were divided into quartiles according to the TyG index: Q1: TyG < 8.55; Q2: 8.55 ≤ TyG ≤ 8.87; Q3: 8.88 ≤ TyG ≤ 9.29; and Q4: TyG > 9.29. Baseline characteristics, laboratory measurements, angiography data, and the incidence of CIN were compared between the groups. CIN was observed in 18 (6.6%) patients in the study. The incidence of CIN was lowest in the Q1 group and highest in the Q4 group (1 (1.5%) in Q1; 3 (4.4%) in Q2; 5 (7.4%) in Q3; 9 (13.2%) in Q4; p = 0.040). TyG index was found to be an independent risk factor for the development of CIN in multivariate logistic regression analysis (odds ratio = 6.58; confidence interval (CI) = 2.12-20.40; p = 0.001). TyG index value of 9.17 was identified as an effective cut-off point for the prediction of CIN (Area under the curve: 0.712, CI: 0.590-0.834, p = 0.003), and it had a sensitivity of 61% and a specificity of 72%. The results of this study showed that a high TyG index increases the incidence of CIN after CAG in non-diabetic NSTEMI patients and is an independent risk factor for the development of CIN.

Serum total bilirubin level is associated with contrast induced nephropathy after primary percutaneous coronary intervention.

Contrast Induced Nephropathy (CIN) is a major complication of angiographic procedures. Primary percutaneous coronary intervention (pPCI) is the preferred treatment for ST-segment elevation myocardial infarction (STEMI) but is associated with a risk of CIN. Oxidative stress and free radical damage play a role in the pathogenesis of CIN. Bilirubin has anti-inflammatory and antioxidant activity and has been shown to have a protective effect on endothelial cells. The present study aimed to assess the association between serum bilirubin level and development of CIN after pPCI. Sequential STEMI patients (n = 595) who underwent pPCI between January 2021 and December 2022 were enrolled. Among the participants, 116 (19.5%) developed CIN. Serum total bilirubin level was significantly lower in the CIN group (P = .001). In multivariate logistic regression analysis, serum bilirubin level was found as an independent predictor of CIN. Age, gender, contrast volume, and white blood cell count were other independent predictors of CIN. A higher serum bilirubin level is associated with a lower risk of CIN in the present study. In STEMI patients undergoing pPCI, serum bilirubin level may be helpful to predict the risk of CIN and may help ensure early initiation of preventive treatment and careful follow-up.

#5471 THE URINARY BIOMARKERS IGFBP7 AND IGFBP7 X TIMP2 PRE-EMPTIVELY IDENTIFY PATIENTS AT RISK OF CONTRAST NEPHROTOXICITY

Abstract Background and Aims Drug nephrotoxicity is a serious medical and economic concern. In fact, 25% of the 100 most used drugs in intensive care units are toxic to the kidney, which limits their use and, therefore, the correct therapy for the patient. The administration of contrast media (CM) during diagnostic tests or surgical interventions carries the risk of contrast-induced nephropathy (CIN), which is a clinical condition defined as an increase in plasma creatinine of 25% or 0.5 mg/dL above baseline within 3-5 days after administration. Because once installed CIN has no treatment, identification of new biomarkers predicting patients at risk of CIN before receiving CM may be crucial to prevent future kidney complications. Clinical studies conducted in other medical areas have identified new urinary biomarkers, such as insulin like growth factor binding protein 7 (IGFBP7) and tissue inhibitor of metalloproteinases 2 (TIMP2), that anticipate the risk of developing kidney damage after the administration of different potentially nephrotoxic compounds. The objective of this work was to evaluate the usefulness of these biomarkers to predict CIN in cardiac patients. Method A clinical study was carried out with 154 patients from the University Hospital of Salamanca Cardiology Department who subsequently received a CM. Prior to contrast administration, urine samples were collected. In addition, their plasma creatinine level was registered for the following 5 days to evaluate the development of CIN. Patients were divided into Controls (who did not develop CIN) and Cases (who developed CIN). IGFBP7 and TIMP2 biomarkers were quantified in urine samples by ELISA. Subsequently, the differences between both groups were evaluated using the Mann-Whitney U test and the diagnostic capacity of each biomarker was analyzed through the generation of its receiver operating characteristic (ROC) curve. Results Of the total number of patients, 123 were assigned to the Controls group and 31 to the Cases group. In both groups the distribution of sex and risk factors was similar, except for the case of age and body mass index, which was slightly lower and higher, respectively, in the Controls group. IGFBP7 was significantly higher in Cases (p &amp;lt; 0.01) compared to the Controls, and the IGFBP7 x TIMP2 product further improved this significance (p &amp;lt; 0.001). Specifically, the area under the ROC curve for IGFBP7 was 0.67 (95% confidence interval of 0.56-0.78); while that for IGFBP7 x TIMP2 increased to 0.73 (with a 95% confidence interval of 0.63-0.84). In contrast, TIMP2 alone showed no differences between both groups of patients. Conclusion The biomarkers IGFBP7 and IGFBP7 x TIMP2 could therefore be used for the prophylactic identification and management of patients at risk of developing CIN.

Assessment of Predictive Value of SYNTAX-II Score for Adverse Cardiac Events and Clinical Outcomes in Patients With Acute Coronary Syndrome.

Prognostic information is important for the management of acute coronary syndrome (ACS). Our aim was to evaluate Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) score-II (SSII) for predicting contrast induced nephropathy (CIN) and one-year major adverse cardiac events (MACE) in ACS patients. Coronary angiographic recordings of 1304 ACS patients were retrospectively examined. Predictive values of SYNTAX score (SS), SSII-percutaneous coronary intervention (SSII-PCI), SSII-coronary artery bypass graft (SSII-CABG) scores for CIN and MACE were assessed. Combination of CIN and MACE ratios constituted primary composite end-point. Patients with SSII-PCI scores >32.55 were compared with patients with lower scores. All of the three scoring systems predicted the composite primary end-point [SS: Area under the curve (AUC): .718, P < .001 (95% CI: .689-.747), SSII-PCI: AUC: .824, P < .001 (95% CI: .800-.849), SSII-CABG: AUC: .778, P < .001 (95% CI: .751-.805)]. Comparison of AUC of receiver operating characteristic curves showed that SSII-PCI score had better predictive value than that of SS and SSII-CABG scores. In multivariate analysis, the only predictor of the primary composite end-point was SSII-PCI score (odds ratio: 1.126, 95% CI: 1.107-1.146, P < .001). SSII-PCI score was a valuable tool for prediction of shock, CABG, myocardial infarction, stent thrombosis, development of CIN and one-year mortality.

Value of systemic inflammation-response index in predicting contrast-induced nephropathy in patients with ST-elevation myocardial infarction

Background Contrast induced nephropathy (CIN) is one of the feared complications of contrast medium-using procedures. Present study was conducted in order to evaluate the value of systemic inflammatory-response index (SIRI) for development of CIN among patients who underwent primary percutaneous intervention. Methods Six hundred seventy-six patients with the diagnosis of ST elevation myocardial infarction were included. The patients were divided into two groups according to the presence of CIN. Patients without (n = 530) and with (n = 146) CIN constituted group 0 and group 1, respectively. Clinical and biochemical features of the patients were recorded. Calculation of SIRI was made for each patient. Result CIN patients were older, had higher prevalence of hyperlipidaemia, higher values of pre- and post-procedural creatinine levels, neutrophil and monocyte counts, neutrophil/lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) and SIRI. They had lower values of left ventricular ejection fraction (LVEF), haemoglobin and high-density lipoprotein-cholesterol levels. SIRI had the highest area under the curve (AUC) for prediction of CIN. Pairwise analyses of the AUC’s demonstrated that SIRI had statistically significantly higher AUC compared to NLR and MLR. Multivariate logistic regression analysis showed that besides from LVEF and pre-procedural creatinine, NLR and SIRI were the independent predictors of CIN. SIRI had a higher odds ratio compared to NLR. Conclusion SIRI had greater diagnostic power than NLR and MLR and it can easily be used by physicians for the identification of high-risk patients for the occurrence of CIN.

Systemic immune-inflammation index associated with contrast-induced nephropathy after elective percutaneous coronary intervention in a case-control study.

Elevated systemic immune-inflammation index (SII) has associated with coronary heart disease and poor clinical outcomes. However, the relationship between SII and contrast-induced nephropathy (CIN) in patients who underwent elective percutaneous coronary intervention (PCI) is still unclear. We aimed to investigate the association of SII with the development of CIN in elective PCI patients. A retrospective study with 241 participants was performed from March 2018 to July 2020. CIN was defined as any of the following: increase in serum creatinine (SCr) level by ≥0.5 mg/dl (≥44.2 mol/L) or increase in SCr to ≥25% over the baseline value within 48-72 h after PCI. The SII levels in patients with CIN ( n = 40) were significantly higher than those without. In correlation analysis, SII positively correlated to uric acid but negatively with the estimated glomerular filtration rate. Increased log2(SII) levels were independent risk factors for patients with CIN [odds ratio (OR) = 2.686; 95% confidence interval (CI), 1.457-4.953]. In the subgroup analysis, increased log2(SII) was strongly associated with the presence of CIN in male participants (OR = 3.669; 95% CI, 1.925-6.992; P < 0.05), whereas no association was found in females (OR = 1.552; 95% CI, 0.533-4.515; P > 0.05). Receiver operating characteristic analysis demonstrated that in a cutoff of 586.19, SII showed 75% sensitivity and 54.2% specificity for predicting CIN in patients undergoing elective PCI, respectively. In conclusion, elevated SII was an independent risk factor of CIN development in patients undergoing elective PCI, particularly in male people.

The Value of C-reactive Protein/Albumin Ratio in the Prediction of Contrast-Induced Nephropathy in Emergency Department Patients.

Contrast-induced nephropathy (CIN) is the third most common cause of acute renal failure in hospitalized patients and is an important cause of prolonged hospital stay, morbidity, and mortality. We aimed to investigate the effectiveness and sufficiency of the prognostic capacity of the inflammatory biomarkers C-reactive Protein (CRP) and albumin ratio (CAR) in predicting the development of CIN in patients undergoing contrast-enhanced computed tomography (CT) imaging in the emergency department (ED). This study was performed on patients whose laboratory values ​​could be reached within 48 hours after contrast-enhanced CT imaging in the emergency department of our hospital. The patients were divided into two groups as those with and without CIN according to their increased creatinine levels. Its effectiveness in detecting the development of CIN in the early period was evaluated comparatively. One hundred and twenty-five patients were included. CIN developed in 10.4% of the patients. The CAR was 0.19 (IQR: 0.17-0.33) in the group with CIN and 0.02 (IQR: 0.01-0.06) in the group without CIN; and the difference between the two groups was significant (p<0.001). In multivariate logistic regression analysis, it was found that the CAR increased as an independent risk factor for CIN (OR: 2.326; 95% CI: 1.39-3.893; p=0.001). We think that early identification of patients who may develop CIN through the CAR in EDs and early initiation of treatment for CIN may affect the morbidity-mortality rate and reduce the duration of hospitalization and treatment costs.