Predictive value of inflammatory factors on contrast‐induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention

Yuan, Ying; Qiu, Hong; Hu, Xiaoying; Luo, Tong; Gao, Xiaojin; Zhao, Xueyan; Zhang, Jun; Wu, Yujuan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin

doi:10.1002/clc.22722

Cited by 62 publications

(56 citation statements)

References 44 publications

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“…33 To incorporate an inflammatory marker in our risk score, we evaluated the NLR which has been recognized as an important marker for inflammation in AKI. 8,9,34,35 In fact, a higher NLR was independently associated with AKI in our study (p=0.028).…”

Section: Discussionsupporting

confidence: 49%

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Gameiro¹,

Fonseca²,

Dias³

et al. 2018

IJNRD

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IntroductionAcute kidney injury (AKI) is common in hospitalized patients with cirrhosis and is associated with poor prognosis. A risk prediction score combining values easily measured at admission could be valuable to stratify patients for prevention, monitoring and early intervention, ultimately improving patient care and outcomes. The aim of this study was to develop a risk score for AKI in a cohort of cirrhotic patients.Patients and methodsWe cross-examined the data from a retrospective analysis of 186 patients with cirrhosis admitted to the Gastroenterology and Hepatology Service of Centro Hospitalar Lisboa Norte from January 2003 to December 2005. AKI was defined as an increase in serum creatinine (SCr)≥0.3 mg/dL within 48 hours or a percentage increase in SCr≥50% from baseline. Neutrophil-to-lymphocyte ratio (NLR) was used as a marker for inflammation. A receiver operating characteristic (ROC) curve was produced to assess the discriminative ability of the variables. Cutoff values were defined as those with highest validity. The final AKI risk score model was assessed using the ROC curve.ResultsA total of 52 patients (28%) developed AKI. Higher baseline SCr (p<0.001), more severe liver disease as evaluated by the modified Model of End-stage Liver Disease (MELD)-Na score (p<0.001) and higher NLR (p=0.028) were independently associated with AKI. The area under the ROC (AUROC) curve for the prediction of AKI was 0.791 (95% CI 0.726–0.847) for SCr, 0.771 (95% CI 0.704–0.829) for modified MELD-Na and 0.757 (95% CI 0.689–0.817) for NLR. Cutoff values with the highest validity for predicting AKI were determined and defined as 0.9 for the SCr, 21.7 for the modified MELD-Na and 6 for the NLR. The risk score was created allowing 3 points if the SCr is higher than 0.9, 1 point if the modified MELD-Na is higher than 21.7 and 1 point if the NLR is higher than 6. The AUROC curve of the risk prediction score for AKI was 0.861. A risk score of ≥2 points predicts AKI in cirrhotic patients with a sensitivity of 88.5% and specificity of 72.4%.ConclusionA new score combining SCr, MELD-Na and NLR demonstrated a strong discriminative ability to predict AKI in cirrhotic patients.

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Section: Discussionsupporting

confidence: 49%

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Gameiro¹,

Fonseca²,

Dias³

et al. 2018

IJNRD

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“…Widespread use of low‐osmolar contrast agents and minimization of contrast use in patients with CKD might explain a lack of association between contrast volume and AKI . Inflammatory markers such as neutrophil‐to‐lymphocyte ratio and high‐sensitivity C‐reactive protein were found to be predictive of contrast‐induced AKI in patients undergoing emergency percutaneous coronary interventions . An interesting area of further investigation would be to attempt to replicate these results in patients undergoing TAVR.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.

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“…The Mehran risk score has been traditionally used to predict CI‐AKI . However, it has been suggested that several inflammatory markers—including white blood cell count, neutrophil count, C‐reactive protein, big endothelin‐1, and urine neutrophil gelatinase‐associated lipocalin—are also important predictors of CI‐AKI . In addition, fragmented QRS complex on 12‐lead electrocardiography has also been shown to be an independent predictor of postprocedural CIN in patients undergoing primary percutaneous coronary intervention …”

Section: Discussionmentioning

confidence: 99%

“…2 However, it has been suggested that several inflammatory markers-including white blood cell count, neutrophil count, C-reactive protein, big endothelin-1, and urine neutrophil gelatinase-associated lipocalin-are also important predictors of CI-AKI. 16,17 In addition, fragmented QRS complex on 12-lead electrocardiography has also been shown to be an independent predictor of postprocedural CIN in patients undergoing primary percutaneous coronary intervention. 18 Several therapies have been investigated for CIN prevention, Recently, a novel strategy to achieve a high urine output through forced diuresis while maintaining euvolemia has been developed using the RenalGuard system.…”

Section: Discussionmentioning

confidence: 99%

High‐volume forced diuresis with matched hydration using the RenalGuard System to prevent contrast‐induced nephropathy: A meta‐analysis of randomized trials

Shah

Wood

Khan

et al. 2017

Clinical Cardiology

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Background Contrast‐induced nephropathy (CIN) is a well‐recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide‐induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints. Hypothesis Forced diuresis with matched hydration using the RenalGuard system improves clinical outcomes in patients undergoing coronary angiography. Methods Scientific databases and websites were searched for relevant RCTs. The pooled risk ratios were calculated using random‐effects models. The primary endpoint was CIN, and the secondary endpoints were major adverse clinical events (MACEs) and the need for renal replacement therapy. Results Data from 3 trials including 586 patients were analyzed. High‐volume forced diuresis with matched hydration using the RenalGuard system decreased risk of CIN by 60% (risk ratio: 0.40, 95% confidence interval: 0.25 to 0.65, P < 0.001), MACE rate by 59%, and the need for renal replacement therapy by 78%, compared with the standard of care. Conclusions In patients with CKD undergoing coronary angiography, high‐volume forced diuresis with matched hydration using the RenalGuard system significantly reduces the risk of CIN, MACE rate, and the need for renal replacement therapy. Larger RCTs with sufficient power are needed to confirm these findings.

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Predictive value of inflammatory factors on contrast‐induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention

Abstract: The WBC count, N count, NLR, CRP level, hs-CRP level, and big ET-1 level are all associated with an increased risk of CI-AKI, and among which, the big ET-1 level, NLR, and the hs-CRP level might have high predictive value for CI-AKI after an emergency PCI.

Cited by 62 publications

References 44 publications

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Prediction of acute kidney injury in cirrhotic patients: a new score combining renal, liver and inflammatory markers

Acute kidney injury post–transcatheter aortic valve replacement

High‐volume forced diuresis with matched hydration using the RenalGuard System to prevent contrast‐induced nephropathy: A meta‐analysis of randomized trials

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