Independent Predictors Of Contrast-induced Nephropathy Research Articles

Role of Elevated Arterial Lactate as a Predictor for Contrast Induced Nephropathy Following Percutaneous Coronary Intervention in Diabetic Patients with ACS

Abstract Background Estimated incidence of contrast induced nephropathy (CIN) from variable prospective studies varied widely and ranged from 0% and up to 24%. This is mainly due to the variation in comorbidities, basal creatinine level and other causes of acute kidney injury. The mechanism of CIN is multifactorial. It has been demonstrated that contrast media decreases the antioxidant activity in the nephron and cause direct cytotoxicity to the renal cells, as well. Objective To assess the role of elevated arterial lactate as a predictor for contrast induced nephropathy following percutaneous coronary intervention in Diabetic patients with acute coronary syndrome. Methods This prospective descriptive study was done on 200 diabetic patients with acute coronary syndrome underwent percutaneous coronary intervention in Ain Shams University during the study period (6 months) from 9/2023 to 2/2024. Results We found that higher pre procedure arterial lactate level was associated with an increased risk of CIN in diabetic patients with ACS after PCI. We found by multivariate analysis that the most statistically significant predictors for occurrence of CIN in the studied group were presence of arterial lactate > 1 and whole procedure time >69 min Conclusion Pre procedure arterial lactate is a strong independent predictor of contrast-induced nephropathy in diabetic patient with acute coronary syndrome underwent PCI.

Predictors of Contrast induced nephropathy following percutaneous coronary intervention in patients with chronic total occlusion

Abstract Objectives The aim is to predict the development of contrast induced nephropathy (CIN) and corresponding parameters in patients with chronic total occlusion (CTO) after per-cutaneous coronary intervention (PCI). Background Up to this moment few data was collected on the effect of different parameters and approaches on the development of contrast induced nephropathy in patients undergoing per- cutaneous coronary intervention to chronic total occlusion (CTO) lesion to coronary vessels. Methods Our study involved 75 patients with documented CTO lesions with planned revascularization over period of 6 months commencing in June 2021. Detailed baseline clinical, angiographic and baseline/follow up creatinine level outcomes were evaluated using data from Ainshams University affiliated hospitals. Results The incidence of CIN among population was 17.3% and 26.7% at 24h and 48h consecutively. Four different parameters showed a good diagnostic value in predicting CIN at 48hrs among patients with CTO who underwent planned elective interventional therapy PCI. The receiver-operating characteristic (ROC) curve analysis for prediction of CIN at 48 h showed that contrast volume (sensitivity, 85%; specificity, 67.0%; AUC, 0.812; 95% CI, 0.705–0.893; P < 0.001); Procedure time (sensitivity, 100%; specificity, 60.0%; AUC, 0.835; 95% CI, 0.731–0.910; P < 0.001); Δ Creatinine at 24 h (sensitivity, 90%; specificity, 76.0%; AUC, 0.918; 95% CI, 0.831–0.969; P < 0.001); Δ% Creatinine at 24 h (sensitivity, 75%; specificity, 96%; AUC, 0.915; 95% CI, 0.827–0.967; P < 0.001) have impact on the development of CIN. The results of multivariable binary logistic regression analysis for prediction of CIN at 48 h. showed that both contrast volume (odds ratio = 1.007, 95% CI = 1.001 to 1.013, p = .021) and Percentage change in creatinine at 24 h (odds ratio = 1.132, 95% CI = 1.053 to 1.218, p = .0008) are independent predictors of CIN at 48 h. Conclusions Contrast volume, Absolute rise/percentage change of serum in creatinine in 24 hrs and procedure time Can be used as a simple pre-procedural predictor of CIN among patients with CTO who undergoing interventional therapy PCI for revascularization.

Left Ventricular End-Diastolic Pressure for the Prediction of Contrast-Induced Nephropathy and Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction Who Underwent Primary Percutaneous Intervention (the ELEVATE Study)

Contrast-induced nephropathy (CIN) is an important complication of percutaneous coronary intervention (PCI). We investigated whether left ventricular end-diastolic pressure (LVEDP) in patients who underwent PCI might be additive to current risk stratification of CIN. Data from consecutive patients who underwent primary PCI for ST-elevation myocardial infarction between 2013 and 2018 at Western Health in Victoria, Australia were analyzed. CIN was defined as a 25% increase in serum creatinine from baseline or 44 µmol/L increase in absolute value within 48 hours of contrast administration. Compared with patients without CIN (n=455, 93%), those who developed CIN (n=35, 7%) were older (64 vs 58 years, p=0.006), and had higher peak creatine kinase (2,862 [1,258 to 3,952] vs 1,341 U/L [641 to 2,613], p=0.02). The CIN group had higher median LVEDP (30 [21-33] vs 25 mmHg [20-30], p=0.013) and higher median Mehran risk score (MRS) (5 [2-8] vs 2 [1-5], p<0.001). Patients with CIN had more in-hospital major adverse cardiovascular and cerebrovascular events (composite end point of death, new or recurrent myocardial infarction or stent thrombosis, target vessel revascularization or stroke) (23% vs 8.6%, p=0.01), but similar 30-day major adverse cardiovascular and cerebrovascular events (20% vs 15%, p=0.46). An LVEDP >30 mmHg independently predicted CIN (odds ratio 3.4, 95% confidence interval 1.46 to 8.03, p=0.005). The addition of LVEDP ≥30 mmHg to MRS marginally improved risk prediction for CIN compared with MRS alone (area-under-curve, c-statistic=0.71 vs c-statistic=0.63, p=0.08). In conclusion, elevated LVEDP ≥30 mmHg during primary PCI was an independent predictor of CIN in patients treated for ST-elevation myocardial infarction. The addition of LVEDP to the MRS may improve risk prediction for CIN.

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.

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.

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.

Predictive value of CHA2DS2VASC score for contrast-induced nephropathy after primary percutaneous coronary intervention for patients presenting with acute ST-segment elevation myocardial infarction

BackgroundST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) are at increased risk for contrast-induced nephropathy (CIN) than elective PCI procedures. Routine calculation of Mehran’s score is limited by its complexity and difficulty to memorize. This study evaluated CHA2DS2-VASc score predictive utility for CIN in STEMI patients before pPCI.ResultsConsecutive 500 acute STEMI patients presenting to two Egyptian pPCI centers were recruited. Exclusion criteria included cardiogenic shock or known severe renal impairment (baseline serum creatinine ≥ 3 mg/dL) or current or previous indication of hemodialysis. CHA2DS2VASC score, Mehran’s score, baseline estimated glomerular filtration rate (eGFR), contrast media volume (CMV) and CMV/eGFR ratio were collected for all patients. Post-pPCI CIN (defined as 0.5 mg/dL absolute increase or 25% relative increase of serum creatinine from baseline) and predictive accuracy of CHA2DS2VASC and Mehran’s scores were evaluated. CIN occurred in 35 (7%) of the study group. Values of CHA2DS2VASC score, Mehran’s score, baseline eGFR, CMV and CMV/eGFR ratio were significantly higher in those who developed CIN compared to those who did not. CHA2DS2VASC score, Mehran’s score and CMV/eGFR were found to be independent predictors for CIN (P < 0.001 for all). ROC curve analysis revealed that CHA2DS2VASC ≥ 4 had a superb predictive ability, comparable to Mehran’s score, for post-pPCI CIN.ConclusionsBeing practical, easily memorizable and applicable before proceeding to pPCI, routine CHA2DS2VASC score calculation in STEMI patients can effectively predict CIN risk and guide preventive and/or therapeutic interventions.

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.

Elektif koroner anjiyografi yapılan hastalarda hipomagnezemi ve kontrast ilişkili nefropati riski ilişkisi

Objective: The present study aimed to assess the influence of hypomagnesemia (hypoMg) on the risk of developing contrast-induced nephropathy (CIN) after coronary angiography.&#x0D; Methods: This is a single-center prospective, observational study conducted at a tertiary referral hospital. Between December 31, 2016, and February 28, 2021, 223 patients who had undergone coronary angiography procedures and had preprocedural baseline Mg levels were enrolled in this study. CIN was defined as an increase of &gt;0.5 mg/dl or &gt;25 % in serum creatinine concentration over baseline within 48-72 h after administration. HypoMg was defined as Mg&lt; 1.60 mg/dL. &#x0D; Results: Of 223 patients enrolled, CIN occurred in 28 patients (12.6%). CIN occurred in 36.4 % of the patients with hypoMg and 11.3 % of those with non-hypoMg (P=0.02). Multivariate logistic regression analysis found that baseline Mg levels were independent predictors of CIN. &#x0D; Conclusion: HypoMg was associated with an increased risk for CIN. These results suggest magnesium replacement in hypomagnesemia may be beneficially indicated before diagnostic/interventional studies using contrast media.

Neutrophil gelatinase-associated lipocalin monitoring reveals persistent subclinical kidney injury following intraarterial administration of iodinated contrast agents

Clinically overt contrast-induced nephropathy (CIN) is one of the most feared complications in patients exposed to iodinated contrast media and has been extensively studied over the years. Meanwhile, the incidence and evolution of subclinical contrast-induced kidney injury remain elusive. With the continuous increase in the number of patients that are repeatedly exposed to contrast media, elucidating these issues is of critical importance. Accordingly, we aimed to evaluate the incidence and the evolution of clinical and subclinical kidney injury in patients exposed to contrast media. A total of 178 patients who underwent elective percutaneous angioplasty procedures were evaluated prospectively. Serum creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels were evaluated pre-procedurally, 48 h and 1 month after administration of contrast media. The evolution of creatinine and NGAL levels was analyzed at the three time points, and the potential predictors of contrast-induced clinical and subclinical renal injury were evaluated. Clinically overt CIN occurred in 10 (5.6%) patients. Baseline serum creatinine and the volume of contrast media were the only independent predictors of CIN and in all 10 patients creatinine levels returned to baseline by 1 month (p = 0.32). Subclinical contrast-induced kidney injury was much more common, affecting 32 (17.9%) patients, was only predicted by the baseline serum creatinine, and persisted in 53.1% of patients after 1 month. This study showed that whereas clinically overt CIN is rather rare and regressive, subclinical contrast-induced kidney injury is considerably more frequent, affecting almost 18% of patients that receive intraarterial contrast media. More importantly, subclinical kidney injury persisted after 1 month in more than 50% of the initially affected patients, who may thus be at increased risk for further renal impairment, particularly if exposed to nephrotoxic agents or repeated administration of contrast media.

Effect of Serum C-Peptide Levels on the Development of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary Angiography.

Contrast-induced nephropathy (CIN) is an important cause of morbidity and mortality, in patients with diabetes who undergo coronary angiography (CAG). It is known that serum C-peptide has renoprotective effects in diabetic nephropathy. Patients with diabetes (n = 552) who underwent CAG in our center between January 2020 and December 2021 were included, retrospectively. The patients were divided into 2 groups: not-developing CIN (group 1) and developing CIN (group 2). CIN developed in 128 (23.1%) of the patients with diabetes who underwent CAG. C-peptide, albumin, hemoglobin, hematocrit, initial creatinine, ejection fraction (EF), were significantly lower in the group that developed CIN compared with the group that did not (P < .05, for all). In correlation analysis, creatinine increase rate (ΔCr) was negatively correlated with C-peptide, hematocrit, and ejection fraction (r = -.241, P < .001; r = -.135, P < .001; r = -.194, P = .001; respectively). In logistic regression analysis, C-peptide level (Odds Ratio: .404, 95% Confidence Interval: .286-.571, P < .001) was an independent predictor of CIN. In the present study, C-peptide level was an independent predictor of CIN in patients with diabetes. This study suggests that low levels of C-peptide are associated with a greater risk of CIN.

Contrast-induced nephropathy following PCI: can we calculate a safe contrast volume?

Abstract Introduction Acute kidney injury (AKI) due to contrast induced nephropathy (CIN) is a common complication after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), and is associated with prolonged hospitalizations and elevated cardio and renovascular morbidity. Scientific evidence demonstrates that the mean volume of contrast (VolC) and ratio with creatinine clearance (CrCl) (VolC/CrCl) are independent predictors of CIN, but the accepted optimal value remains controversial. Objective Population characterization. To evaluate whether the calculation of VolC using the VolC/ClCr ratio &amp;lt;3.7 used in our Cath lab during PCI of ACS allows preventing the development of AKI by CIN, and whether the development of early vs late AKI influences outcomes. Methods Retrospective study between 2017/2020, composed of n=378 patients who suffered ACS. Descriptve analysis was carried out regarding the demographic and clinical characteristics of the patients. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%. Results A total of 378 patients were identified, with a mean age of 64.5±11.2 years, 78.6% were male. 60.1% had hypertension, 48.4% dyslipidemia, 24.3% diabetes, 2.6% chronic renal failure (CRF) and 1.6% heart failure. Of these, 12.7% developed AKI (&amp;lt;24h in 1.9% vs ≥24h in 10,8%). Indepedent prognostic factors for development of AKI were smokers (AKI ≥24h 7 (4.8%) vs AKI&amp;lt;24h 2 (1.4%), p=0.001), diabetes (AKI≥24h 17 (19%) vs AKI &amp;lt;24h 2 (2.2%), p=0.007), CRF (AKI ≥24h 6 (60%) vs AKI &amp;lt;24h 1 (10%), p=0.001), CrCl (AKI ≥24h 65.8±27.1, p=0.001), ratio VolC/CrCl (AKI ≥24h 3.3±2.5, p=0.001) and LVEF (AKI ≥24h 51.4±9.7, p=0.001). Mortality afected 4.2% of the patients, and was more frequente in AKI subjects (AKI ≥24h 7 (70%) vs AKI &amp;lt;24h 1 (10%), p=0.001). Using a ratio &amp;lt;3.7 allowed to prevent AK &amp;lt;24h but not AKI ≥24h (AKI &amp;lt;24h ratio &amp;lt;3.7 = 3 (1%) vs ratio ≥3.7 = 9 (4.1%), p=0.001) (AKI ≥24 ratio &amp;lt;3.7 = 30 (25%) vs ratio ≥3.7 = 11 (9.7%), p=0.001). A ratio &amp;lt;2.0 allowed to prevent both early and late AKI (AKI &amp;lt;24h ratio &amp;lt;2.0 = 0 (0%) vs ratio ≥2.0 = 7 (4.5%), p=0.001) (AKI ≥24 ratio &amp;lt;2.0 = 11 (5.6%) vs ratio ≥2.0 = 30 (19.1%), p=0.001). Conclusion In patients submitted to ACS PCI, the development of AKI increases mortality, especial if AKI emerge after 24h. We report a more suitable ratio VolC/ClCr &amp;lt;2.0, that allow us to calculate a safe VolC that will help to prevent both early and late AKI in selected patients wtih ACS. Funding Acknowledgement Type of funding sources: None.

SHOCK INDEX-C: A NEWFOUND SPECTRUM OF SHOCK INDEX WITH GREAT ACCURACY TO PREDICT CONTRAST INDUCED NEPHROPATHY IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION COHORT

Objectives: This study was conducted to assess the predictive value of Shock Index-Creatinine Clearance (SI-C) for the risk stratification of contrast induced nephropathy (CIN) in patients after primary percutaneous coronary intervention (PPCI). Methodology: 1150 consecutive patients of STEMI and candidates of PPCI presenting at our tertiary care cardiac center were included in this study. Patients with significant hemodynamic instability, allergic reaction to contrast agent or having exposure to contrast agent within a week prior to PPCI and those requiring renal replacement therapy were excluded from this study. SI-C and Mehran risk scores were calculated and the rise in post procedure serum creatinine level by 0.5 mg/dL or up to 25% from baseline was characterized as CIN. The predictive power of both SIC and Mehran risk score was assessed with help of receiver operating characteristic (ROC) curve analysis. Results: Out of 1150 participants, 960 were male with a mean age of 55.64 ± 11.45 years. Out of which 113 (9.8%) patients developed CIN. Area under the cure (AUC) for the prediction of CIN was 0.702 [95% confidence interval (CI): 0.651 to 0.753] for SI-C as against 0.633 [95% CI: 0.574 to 0.692] for Mehran score. SIC also retained its statistical significance as independent predictor of CIN with adjusted odds ratio of 1.01 [95% CI: 1.01 to 1.02] on multivariable regression analysis. Conclusion: SI-C has demonstrated strong discriminative power to determine the risk of CIN in PPCI setting when compared with Mehran risk score.

Risk factors of contrast-induced nephropathy in patients with acute coronary syndrome

Patients with acute coronary syndrome (ACS) are at high risk of contrast-induced nephropathy (CIN), which is associated with prolonged hospitalization, higher morbidity and mortality after angiographic procedures. The occurrence of CIN is regarded as a transient and reversible condition. However, the persistence of CIN until hospital discharge in patients with ACS has not been thoroughly analyzed. We aimed to analyze CIN persistent until hospital discharge in contemporary ACS population referred to invasive diagnostics and treatment. A total of 2638 consecutive patients with ACS were included in a prospective registry. The occurrence of CIN was defined as a 25% increase in serum creatinine from baseline or a 0.5 mg/dl (44 μmol/l) increase in the absolute value. Criteria of CIN at hospital discharge were met in 10.7% of patients. Immediate percutaneous coronary intervention (PCI) after angiography (67% of patients) was associated with higher rates of CIN compared to patients referred for other treatment strategies (P < 0.001). The logistic regression model showed that anemia at baseline (8.7% of patients) was an independent predictor of CIN, which occurred in 17.9% of anemic patients and 10% of patients without anemia (P < 0.001). Also, ST-segment elevation myocardial infarction (STEMI) presentation and immediate PCI were independent predictors of CIN. Despite intravenous fluid administration during the hospital stay, CIN persisted until hospital discharge in more than 10% of patients with ACS. Anemia at baseline, STEMI presentation, and immediate PCI strategy were independent predictors of CIN. Thus, preventive actions should be specially aimed at those groups of patients.

Atherogenic Index of Plasma is an Independent Risk Factor for Contrast Induced Nephropathy in Patients With Non-ST Elevation Myocardial Infarction.

This study investigated the role of atherogenic index of plasma (AIP) in predicting contrast induced nephropathy (CIN) in patients who underwent percutaneous coronary intervention due to non-ST elevated myocardial infarction. Of these, 1644 patients were included in the study. Retrospective data of patients were obtained from hospital records. For the diagnosis of CIN, peri-procedural patient records were scanned. There was a significant difference between age, diabetes mellitus, hyperlipidemia, albumin, high density lipoprotein cholesterol, triglycerides, number of stenotic vessels, creatinine increase rate, baseline creatinine, hemoglobin, hematocrit, AIP, and two groups (CIN- and CIN+) (P < .05, for all). In multivariate logistic regression analysis, AIP was an independent predictor of CIN (odds ratio: 20.352, 95% CI: 12.696-32.624, P < .001). Receiver operating characteristic analysis showed that AIP values of ≥.62 could predict CIN with a sensitivity of 70% and specificity of 58% for predicting CIN (area under curve = .710, P < .001). Atherogenic index of plasma may be helpful as a biomarker to predict CIN.

Serum Uric Acid to Albumin Ratio Can Predict Contrast-Induced Nephropathy in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention.

Contrast-induced nephropathy (CIN) is one of the common complication of ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI). Serum uric acid to albumin ratio (UAR) is a novel marker, which is associated with acute kidney injury in intensive care unit patients. We investigated the predictive value of UAR for the development of CIN in STEMI patients (n = 1379) after pPCI. The diagnosis of CIN was made based on an increase of basal creatinine levels >.5mg/dL or 25% within 72 h after pPCI; 128 patients were in the CIN (+) group and 1251 patients were in the CIN (-) group. CIN (+) patients had higher serum uric acid (SUA), UAR, and lower albumin levels than CIN (-) patients. Age, diabetes, hypertension, hemoglobin, glucose at admission, basal creatinine, peak troponin I, total bilirubin, contrast volume/glomerular filtration rate, and UAR were independent predictors of CIN. A cutoff value of 1.62 for UAR detected CIN development with a sensitivity of 54% and specificity of 87.4%, and the discrimination ability of UAR was better than that of SUA or albumin. In conclusion, UAR was an independent predictor of the development of CIN.

The predictive value of the prognostic nutritional index for contrast-induced nephropathy

Aim: This study aims to evaluate the association between prognostic nutritional index (PNI) and contrast-induced nephropathy (CIN). Material and methods: A total of 251 patients who were at high risk for contrast nephropathy were included in the study. The patients were grouped according to their PNI score (PNI score <45 or PNI score ≥45). CIN was defined as a 25% relative increase, or 0.5 mg/dL absolute increase in serum creatinine level above baseline within 72 hours of contrast exposure, in the absence of an alternative explanation. Results: Two groups were assigned according to the PNI score. The first group consists of 111 patients (PNI<45) and the second group has 140 patients (PNI≥45). CIN developed in 162 (%64.8) patients. C-reactive protein was higher in the low-PNI group. Also, the patients with the low-PNI group had lower ejection fraction, lower serum albumin levels, and lower hemoglobin levels. CIN, postprocedure renal replacement therapy requirement and in-hospital mortality were higher in the low PNI group. Multivariable logistic regression analysis revealed that advanced age (p=0.012, [OR] = 1.044 [1.009-1.079]), low baseline GFR (p=0.033, [OR]= 1.022 [1.002-1.043]), high amount of contrast media (p=0.022, [OR]= 1.017 [1.002-1.031]), and low PNI score (p=0.033 , [OR]= 2.069 [1.060-4.039]) were independent predictors of CIN. Conclusion: Our study demonstrated that the PNI score was an independent risk factor for the development of CIN.

Association of the Novel Inflammatory Marker Systemic Immune-Inflammation index and Contrast-Induced Nephropathy in Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis.

This study investigated whether the systemic immune-inflammation index (SII) is an independent predictor of contrast-induced nephropathy (CIN) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. TAVR patients (n = 130) were included in the study. The patients were divided into 2 groups: those who developed CIN [CIN (+)] and those who did not [CIN (-)]. The SII was calculated as the ratio of the product of the total neutrophil count and the total platelet count to the lymphocyte count. CIN developed in 20 (15.3%) patients after TAVR. White blood cell count (7.66 ± 1.75 vs 6.78 ± 1.71 103/mm3P = .038), neutrophil count (5.1 (3.9-6.7) vs 4.2 (3.5-5.1) 103/mm3P = .024), neutrophillymphocyte ratio (4.20 (2.39-7.00) vs 2.75 (2.06-3.88), P = .010) and SII index (1069 (616-1514) vs 598 (426-955), P = .003) were at higher levels in patients with CIN. In addition, the SII index was an independent predictor for the development of CIN. The SII index, which can be easily calculated from a complete blood count, is an independent predictor of CIN in patients undergoing TAVR for severe aortic stenosis.

The Utility of Systemic Immune-Inflammation Index for Predicting Contrast-Induced Nephropathy in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Objective: The systemic immune-inflammation index (SII), derived from counts of neutrophils, platelets, and lymphocytes, has been developed to predict clinical outcomes in several cancers and cardiovascular diseases. The aim of this study was to evaluate the utility of SII to predict contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). Methods: A total of 632 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups based on the presence or absence of CIN. Baseline demographic, laboratory, and clinic characteristics were evaluated between the two groups. Logistic regression analysis was used to identify independent predictors of CIN. Results: The receiver operating characteristic curve analysis demonstrated that the optimal cutoff value of SII for predicting CIN was 1,282 with a sensitivity of 76.1% and specificity of 86.7% (AUC: 0.834; 95% CI: 0.803–0.863; p < 0.001). Multivariate analysis performed in two models (SII; as separate continuous and categorical variables) showed age, estimated glomerular filtration rate (eGFR), diabetes, left ventricular ejection fraction (LVEF), Killip class ≥2, use of an intravenous diuretic, troponin I, and SII as independent predictors of CIN in model 1. In model 2, age, eGFR, diabetes, LVEF, Killip class ≥2, use of an intravenous diuretic, troponin I, and a value of SII >1,282 (p < 0.001, OR 6.205, 95% CI: 2.301–12.552) remained as independent predictors of CIN. Conclusion: SII may be a useful and reliable indicator to predict the development of CIN in patients with STEMI undergoing primary PCI than NLR and PLR.

The effect of whole blood viscosity on contrast-induced nephropathy development in patients undergoing percutaneous coronary intervention

ABSTRACT Objective In our study, we aimed to investigate how whole blood viscosity (WBV) affects the development of contrast-induced nephropathy (CIN) in patients undergoing percutaneous coronary intervention (PCI). Methods In our study, 500 patients who applied to the cardiology clinic and underwent PCI for elective procedure, ST segment elevation myocardial infarction (STEMI), and non-STEMI were prospectively included. Before the procedure, we calculated WBV using the formula [(0.12× hematocrit) + (0.17×(total protein – 2.07)]. We defined CIN as the absolute (≥0.5 mg/dl) or relative increase (≥25%) in serum creatinine 48–72 h after exposure to a contrast agent compared with baseline serum creatinine values. Results CIN was developed in 69 (13.6%) of the 500 patients in the study. PCI was performed in 206 patients (41.2%) electively, 175 (35%) due to non-STEMI, and 119 (23%) due to STEMI. CIN was observed in 20.2% of the STEMI group, 13.7% of the non-STEMI group, and 10.2% of the elective PCI group. Multivariate logistic regression analysis results show that the independent predictors of CIN are low ejection fraction [OR:0.95 (95% CI:0.92–0.97); p < 0.001], low glomerular filtration rate [OR:0.96 (95% CI:0.95–0.98); p < 0.001], and increased amount of contrast agent [OR:1.008 (95% CI:1.004–1.01); p < 0.001]. When all patients were examined, no significant relationship was found between WBV and CIN. However, in the subgroup evaluation, it was concluded that low WBV was an independent predictor in elective PCI patients [OR:0.60 (95% CI:0.36–0.99); p = 0.04] for CIN. Conclusion We found that low WBV was an independent predictor of CIN in patients undergoing elective PCI(NCT04703049).