Inflammatory Indicators and Hematological Indices in Contrast-Induced Nephropathy Among Patients Receiving Coronary Intervention: A Systematic Review and Meta-Analysis

Abstract

Strong inflammatory indicators such as C-reactive protein (CRP), high-sensitivity CRP (hsCRP), and hematological indices, including platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), hematocrit (HCT), and red blood cell distribution width (RDW), may be related with contrast-induced nephropathy (CIN). Our meta-analysis aimed at exploring the relationship between these indicators and CIN incidence among patients undergoing coronary intervention. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and Science Direct from their inception to June 3, 2020. Meta-analysis was performed on pooled eligible studies. Finally, 26 studies involving 29 454 patients were included. Pooled analysis revealed that patients with higher CRP (odds ratio [OR] = 1.06, 95% CI: 1.01-1.12, P = .02), hsCRP (OR = 1.03, 95% CI: 1.01-1.06, P = .004), NLR (OR = 1.11, 95% CI: 1.01-1.20, P = .02), RDW (OR = 1.35, 95% CI: 1.19-1.53, P < .001), and lower HCT (OR = 0.94, 95% CI: 0.92-0.97, P = .003) all exhibited significantly higher CIN rates, but there was no significant association between PLR and CIN risk (OR = 1.12, 95% CI: 0.99-1.26, P = .07). Pre-angiography CRP/hsCRP and some hematological indices are associated with CIN.

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

“…CRP and hematological indices were also generally investigated in a smaller number of studies conducted on patients with stable angina pectoris, but CAR has been not evaluated yet. 4,5,10 We demonstrated firstly that high CAR was an independent predictor of CIN in patients with SAP. The CAR is simpler to derive than the Mehran Score.…”

“…However, there was no association between PLR and CIN in the meta-analysis. 10 Similarly, a recent study conducted on acute coronary syndrome patients also showed that elevated NLR was an independent predictor of CIN, while another demonstrated that MPVLR was strongest predictor of CIN. 18,19 However, both studies did not include CRP in their studies which is a traditional inflammatory marker.…”

“…7,9,17 In addition to CRP, cystatin-C, procalcitonin, NLR, PLR, MPVLR, and systemic immune-inflammation index may be independent predictors of CIN. 7,10,[18][19][20] A recent study, which investigated the relationship between plasma endothelial microparticles and CIN in patients who underwent CAG, demonstrated that cystatin-C, high-sensitivity CRP, and uric acid were significantly higher in patients with CIN than ones without CIN. 8 The researchers found that elevated microparticles in CIN patients correlated with interleukin-6 and high-sensitivity CRP, and reported that high cystatin-C, uric acid, and N-terminal pro-brain natriuretic peptide were the predictors of CIN rather than high-sensitivity CRP.…”

“…4 In addition, the role of inflammation is known well-known in CIN. 3,10,15 CRP is a strong indicator of the inflammation, and its importance in cardiovascular diseases has been reported in many studies. 11,16 Similarly, recent studies proved that high CRP levels were associated with the development of CIN following some procedures, including CAG.…”

“…4,6 Studies reported the relation of inflammation markers including the C-reactive protein (CRP), high sensitivity-CRP, procalcitonin, cystatin-C, uric acid, the neutrophil to lymphocyte ratio (NLR), the platelet to lymphocyte ratio (PLR), red cell distribution width (RDW), and hematocrit with the development of CIN. [7][8][9][10] Recent studies have reported the importance of the CRP to albumin ratio (CAR) in some clinical conditions, and that CAR can be a useful indicator of coronary artery disease severity. [11][12][13][14] It has been reported that CAR is an important predictor of CIN development in patients with myocardial infarction.…”