C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast Induced Nephropathy in Patients With Stable Angina Pectoris

Abstract

The relationship between C-reactive protein (CRP) to albumin ratio (CAR) and contrast-induced nephropathy (CIN) in patients with acute coronary syndrome has been reported. However, the relevance of CAR in patients with stable angina pectoris (SAP) has not been clarified. We hypothesized that CAR might predict the development of CIN in patients with SAP undergoing coronary angiography (CAG). Patients ( n = 554) with SAP who underwent CAG were included in the study. CIN was defined as a ≥25% increase in serum creatinine compared with baseline value within 72 h of CAG. Participants were divided into two groups: CIN ( n = 87) and non-CIN ( n = 467). Age, CRP, CAR, mean corpuscular volume (MCV), urea, uric acid, contrast medium volume, the percent of percutaneous coronary intervention were significantly greater, whereas albumin and high-density lipoprotein were significantly lower in the CIN group than non-CIN group ( p < .05, for all). Multivariate analysis showed that CAR was the only independent predictor for CIN (odds ratio = 7.065, 95% confidence interval (CI); 3.279–15.221, p < .001). Receiver operating characteristic ROC analysis showed that a CAR ≥ 0.1164 could predict CIN (sensitivity of 71% and specificity of 72%; area under curve = 0.736; 95% CI: 0.677–0.795, p < .001). CAR was significantly greater in patients who developed CIN and this independently predicted CIN.

Letter: C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast-Induced Nephropathy in Patients With Stable Angina Pectoris

“…We read the article by Ibrahim et al entitled “C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast-Induced Nephropathy in Patients with Stable Angina Pectoris” with interest. 1 We agree that a raised C-reactive protein/albumin ratio (CAR) is a risk factor for developing of contrast-induced nephropathy (CIN) in patients with stable angina pectoris (SAP). Recently, many studies also reported the association between CIN and CAR after myocardial infarction.…”

“…The systemic immune-inflammation index (SII) has been considered as a predictor of CIN and is superior to neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP). 14-17 Did the authors 1 calculate SII? If yes, which one is a better predictor of CIN, SII or CAR?…”

“…Finally, the estimated glomerular filtration rate (eGFR) was not reported in this study. 1 The eGFR is a significant risk factor for CIN. 20…”

Response to Letter: C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast-Induced Nephropathy in Patients With Stable Angina Pectoris

“…We thank the authors for their interest in our article. 2 We calculated the immune-inflammation index (SII) after their comments. SII had a skewed distribution; therefore, we used the Man-Whitney U test for comparisons.…”

“…7 However, we had included the other parameters of the Mehran score (contrast volume, blood pressure, age, hemoglobin, diabetes, and basal creatinine levels) in our study and compared them with CAR and other inflammatory parameters. 2…”