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Li Y, Chan TM, Feng J, Tao L, Jiang J, Zheng B, Huo Y, Li J. A pattern-discovery-based outcome predictive tool integrated with clinical data repository: design and a case study on contrast related acute kidney injury. BMC Med Inform Decis Mak 2022; 22:103. [PMID: 35428291 PMCID: PMC9013021 DOI: 10.1186/s12911-022-01841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Clinical data repositories (CDR) including electronic health record (EHR) data have great potential for outcome prediction and risk modeling. We built a prediction tool integrated with CDR based on pattern discovery and demonstrated a case study on contrast related acute kidney injury (AKI). Methods Patients undergoing cardiac catheterization from January 2015 to April 2017 were included. AKI was identified based on Acute Kidney Injury Network definition. Predictive model including 16 variables covered in existing AKI models was built. A visual analytics tool based on pattern discovery was trained on 70% data up to August 2016 with three interactive knowledge incorporation modes to develop 3 models: (1) pure data-driven, (2) domain knowledge, and (3) clinician-interactive, which were tested and compared on 30% consecutive cases dated afterwards. Results Among 2560 patients in the final dataset, 189 (7.3%) had AKI. We measured 4 existing models, whose areas under curves (AUCs) of receiver operating characteristics curve for the test dataset were 0.70 (Mehran's), 0.72 (Chen's), 0.67 (Gao's) and 0.62 (AGEF), respectively. A pure data-driven machine learning method achieves AUC of 0.72 (Easy Ensemble). The AUCs of our 3 models are 0.77, 0.80, 0.82, respectively, with the last being top where physician knowledge is incorporated. Conclusions We developed a novel pattern-discovery-based outcome prediction tool integrated with CDR and purely using EHR data. On the case of predicting contrast related AKI, the tool showed user-friendliness by physicians, and demonstrated a competitive performance in comparison with the state-of-the-art models.
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2
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Arnould L, Guenancia C, Binquet C, Delcourt C, Chiquet C, Daien V, Cottin Y, Bron AM, Acar N, Creuzot-Garcher C. [Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]. J Fr Ophtalmol 2021; 45:104-118. [PMID: 34836702 DOI: 10.1016/j.jfo.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.
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Affiliation(s)
- L Arnould
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Centre d'investigation clinique 1432, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France.
| | - C Guenancia
- Service de cardiologie, CHU de Dijon, Dijon, France; Laboratoire PEC 2, Dijon, France
| | - C Binquet
- Centre d'investigation clinique 1432, Dijon, France
| | - C Delcourt
- Inserm U1219, équipe LEHA, université de Bordeaux, Bordeaux, France
| | - C Chiquet
- Service d'ophtalmologie, CHU de Grenoble, Grenoble, France
| | - V Daien
- Service d'ophtalmologie, CHU de Montpellier, Montpellier, France
| | - Y Cottin
- Service de cardiologie, CHU de Dijon, Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - N Acar
- Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
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3
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Yang JQ, Guo XS, Ran P, Hu XM, Tan N. The relationship between pre-procedural elevated arterial lactate and contrast-induced nephropathy following primary percutaneous coronary intervention. J Thorac Dis 2021; 13:5467-5476. [PMID: 34659813 PMCID: PMC8482345 DOI: 10.21037/jtd-21-1153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/05/2021] [Indexed: 01/01/2023]
Abstract
Background Risk stratification has been one of the main steps in preventing contrast-induced nephropathy (CIN), which is a common complication after percutaneous coronary intervention (PCI). Elevated arterial lactate is a biomarker indicating severe disease condition and post-intervention complications. The relationship between lactate and CIN has not been established. This study is performed to investigate the relationship between elevated arterial lactate level and contrast-induced nephropathy (CIN). Methods Patients diagnosed with ST-segment elevated myocardial infarction (STEMI) were prospectively enrolled, with lactate measured within 0.5–1 hours before primary percutaneous coronary intervention (PCI). Patients with cardiopulmonary resuscitation, any forms of severe anaerobic condition, or end-stage renal disease undergoing dialysis were excluded. CIN was defined as an increase in serum creatinine ≥0.5 mg/dL or 25% within 72 hours after PCI. The Mehran Risk Score (MRS) is widely regarded as a classic risk model for CIN and the risk factors of MRS were applied in our multivariate regression analysis. Results Of the 227 enrolled patients, 47 (20.7%) developed CIN according to the definition. The mean lactate level was higher in the CIN group than in the non-CIN group (2.68±2.27 vs. 1.74±1.94, P<0.001). The arterial lactate level ≥2.0 mmol/L had 57.5% sensitivity and 75.6% specificity in predicting CIN. The performance of the lactate level in discriminating CIN was similar to that of the MRS (AUClac =0.707 vs. AUCMRS =0.697, P=0.86). After adjusting for other risk factors, lactate ≥2.0 mmol/L still significantly predicted CIN (odds ratio =3.77, 95% CI, 1.77–7.99, P=0.001). Conclusions An arterial lactate level of ≥2.0 mmol/L is associated with CIN in STEMI patients after primary PCI.
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Affiliation(s)
- Jun-Qing Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-Sheng Guo
- Department of Intensive Care Unit, Zhuhai Golden Bay Center Hospital, Guangdong Provincial People's Hospital Zhuhai Hospital, Zhuhai, China
| | - Peng Ran
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiang-Ming Hu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Tan
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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4
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Lin J, Chen J, Wu D, Li X, Guo X, Shi S, Lin K. Biomarkers for the early prediction of contrast-induced nephropathy after percutaneous coronary intervention in adults: A systematic review and meta-analysis. Angiology 2021; 73:207-217. [PMID: 34461746 DOI: 10.1177/00033197211039921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Contrast-induced nephropathy (CIN) is a complication of patients undergoing percutaneous coronary intervention (PCI). Promising biomarkers for the early prediction of CIN can significantly improve outcomes of these patients. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies. Trials reporting an area under the curve (AUC) for the utility of novel biomarkers in the early prediction of CIN in adults after PCI were included. In total, 42 studies comprising 11,984 adult patients undergoing PCI met the criteria. Four urinary biomarkers and four blood biomarkers were included. For urine biomarkers, the pooled AUCs for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid-binding protein (L-FABP), and kidney injury molecule-1 (KIM-1) were 0.91 (95% CI 0.89-0.94), 0.79 (0.75-0.82), 0.78 (0.74-0.82), and 0.79 (0.76-0.83), respectively. The blood biomarkers NGAL, cystatin C, brain natriuretic peptide (BNP), and C-reactive protein (CRP) had pooled AUCs of 0.93 (0.91-0.95), 0.92 (0.89-0.94), 0.78 (0.74-0.81), and 0.75 (0.71-0.79), respectively. Subgroup analysis showed that blood NGAL in early CIN predictive time (<6 h) was more effective in predicting CIN. The efficiency of cystatin C in predicting CIN was reduced, whereas that of L-FABP was increased among chronic kidney disease (CKD) patients.
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Affiliation(s)
- Jing Lin
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Jialong Chen
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Dansen Wu
- 74551Shengli Clinical Medical College of Fujian Medical University, China.,Department of Medical Intensive Care Unit, 117861Fujian Provincial Hospital, China
| | - Xiuhua Li
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Xiaolan Guo
- 74551Shengli Clinical Medical College of Fujian Medical University, China
| | - Songjing Shi
- 74551Shengli Clinical Medical College of Fujian Medical University, China.,Department of Medical Intensive Care Unit, 117861Fujian Provincial Hospital, China
| | - Kaiyang Lin
- 74551Shengli Clinical Medical College of Fujian Medical University, China.,Department of Cardiology, 117861Fujian Provincial Hospital, China
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5
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Wu X, Ma C, Sun D, Zhang G, Wang J, Zhang E. Inflammatory Indicators and Hematological Indices in Contrast-Induced Nephropathy Among Patients Receiving Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology 2021; 72:867-877. [PMID: 33719591 DOI: 10.1177/00033197211000492] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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.
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Affiliation(s)
- Xiaoyan Wu
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Ma
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daqing Sun
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Guojing Zhang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jinmiao Wang
- Department of Pediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Enyuan Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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6
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Yin W, Zhou G, Zhou L, Liu M, Xie Y, Wang J, Zuo S, Liu K, Hu C, Chen L, Yang H, Zuo X. Validation of pre-operative risk scores of contrast-induced acute kidney injury in a Chinese cohort. BMC Nephrol 2020; 21:45. [PMID: 32041557 PMCID: PMC7011449 DOI: 10.1186/s12882-020-1700-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 01/20/2020] [Indexed: 01/09/2023] Open
Abstract
Background Pre-operative risk scores are more valuable than post-procedure risk scores because of lacking effective treatment for contrast-induced acute kidney injury (CI-AKI). A number of pre-operative risk scores have been developed, but due to lack of effective external validation, most of them are also difficult to apply accurately in clinical practice. It is necessary to review and validate the published pre-operative risk scores for CI-AKI. Materials and methods We systematically searched PubMed and EMBASE databases for studies of CI-AKI pre-operative risk scores and assessed their calibration and discriminatory in a cohort of 2669 patients undergoing coronary angiography or percutaneous coronary intervention (PCI) from September 2007 to July 2017. The definitions of CI-AKI may affect the validation results, so three definition were included in this study, CI-AKI broad1 was defined as an increase in serum creatinine (Scr) of 44.2 μmol/L or 25%; CI-AKI broad2, an increase in Scr of 44.2 μmol/L or 50%; and CI-AKI-narrow, an increase in Scr of 44.2 μmol/L. The calibration of the model was assessed with the Hosmer-Lemeshow test and the discriminatory capacity was identified by C-statistic. Results Of the 8 pre-operative risk scores for CI-AKI identified, 7 were single-center study and only 1 was based on multi-center study. In addition, 7 of the scores were just validated internally and only Chen score was externally validated. In the validation cohort of 2669 patients, the incidence of CI-AKI ranged from 3.0%(Liu) to 16.4%(Chen) for these scores. Furthermore, the incidence of CI-AKI was 6.59% (178) for CI-AKI broad1, 1.44% (39) for CI-AKI broad2, and 0.67% (18) for CI-AKI-narrow. For CI-AKI broads, C-statistics varied from 0.44 to 0.57. For CI-AKI-narrow, the Maioli score had the best discrimination and calibration, what’s more, the C-statistics of Maioli, Chen, Liu and Ghani was ≥0.7. Conclusion Most pre-operative risk scores were established based on single-center studies and most of them lacked external validation. For CI-AKI broads, the prediction accuracy of all risk scores was low. The Maioli score had the best discrimination and calibration, when using the CI-AKI-narrow definition.
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Affiliation(s)
- Wenjun Yin
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ge Zhou
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lingyun Zhou
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Mancang Liu
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yueliang Xie
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jianglin Wang
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Shanru Zuo
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Kun Liu
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Can Hu
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Linhua Chen
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Huiqin Yang
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaocong Zuo
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha, China. .,Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, China.
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7
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Lin KY, Wang SY, Jiang H, Chen HC, Wu ZY, Guo YS, Zhu PL. Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention. BMC Nephrol 2019; 20:201. [PMID: 31159763 PMCID: PMC6545736 DOI: 10.1186/s12882-019-1386-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/15/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND A low FT3 level is significantly associated with a variety of kidney disease and acute myocardial infarction (AMI). However, it remains unclear whether low FT3 is associated with CI-AKI in patients who underwent pPCI. METHODS Single-center retrospective study evaluated 363 STEMI patients undergoing pPCI. Patients were classfied into 2 groups, low FT3 group (FT3 < 3.1 pmol/L) and normal FT3 group (FT3 ≥ 3.1 pmol/L);CI-AKI was defined as an increase in the serum creatinine levels of ≥50% or 0.3 mg/dL above the baseline level within 48 h after contrast medium exposure. RESULTS Overall, 80(22.0%) patients had low FT3, and 59(16.3%) patients developed CI-AKI. The incidence of CI-AKI and in-hospital mortality was significantly higher in patients with low FT3 than normal (31.3% vs 12.0%; 15.0% vs 3.2%, respectively, both p < 0.0001). Multivariate logistic regression analysis indicated that low FT3 was an independent predictor of CI-AKI (odds ratio [OR] = 2.62, 95%CI:1.35-5.07, p < 0.05). In addition, low FT3 was associated with an increased risk of all-cause mortality during a mean follow-up period of 20 months (hazard ratio [HR] = 2.54, 95%CI:1.15-5.60, p < 0.05). CONCLUSION Low FT3 was associated with CI-AKI, short- and long-term mortality in STEMI patients after pPCI.
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Affiliation(s)
- Kai-Yang Lin
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Sun-Ying Wang
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Hui Jiang
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Han-Chuan Chen
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Zhi-Yong Wu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China
| | - Yan-Song Guo
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
| | - Peng-Li Zhu
- Department of Cardiology, Fujian Provincial Hospital, Fujian Medical University, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
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8
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Alan G, Guenancia C, Arnould L, Azemar A, Pitois S, Maza M, Bichat F, Zeller M, Gabrielle PH, Bron AM, Creuzot-Garcher C, Cottin Y. Retinal Vascular Density as A Novel Biomarker of Acute Renal Injury after Acute Coronary Syndrome. Sci Rep 2019; 9:8060. [PMID: 31147610 PMCID: PMC6543041 DOI: 10.1038/s41598-019-44647-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
Iodinated contrast agent (ICA)-induced acute kidney injury (AKI) following acute coronary syndrome (ACS) is a frequent complication, which may lead to chronic kidney disease and increased mortality. Optical coherence tomography angiography (OCT-A) of the retina is new tool delivering a rapid and noninvasive assessment of systemic microvascularization, which is potentially involved in the occurrence of ICA-induced AKI. Between October 2016 and March 2017, 452 ACS patients were admitted to our cardiac intensive care unit. OCT-A was performed within 48 h after the ICA injection. Patients with a history of retinal disease were excluded. The patients included were divided into two groups depending on whether or not AKI occurred after injection of ICA, according to KDIGO criteria. Of the 216 patients included, 21 (10%) presented AKI. AKI was significantly associated with age, Mehran score, GRACE score, and NT-proBNP. AKI patients had significantly lower retinal vascular density (RVD)) and had more frequent low RVD (81% vs 45%, P = 0.002). Adding low RVD to the Mehran score and the NT-proBNP, or to the GRACE score and the NT-proBNP, significantly improved their predictive values, suggesting that systemic microvascular involvement remains incompletely addressed by either standard risk scores or factors known to be associated with ICA-induced AKI.
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Affiliation(s)
- Guillaume Alan
- Cardiology Department, University Hospital, Dijon, France
| | - Charles Guenancia
- Cardiology Department, University Hospital, Dijon, France. .,PEC 2, Univ. Bourgogne Franche-Comté, Dijon, France.
| | - Louis Arnould
- Ophthalmology Department, University Hospital, Dijon, France.,INSERM, CIC1432, clinical epidemiology unit, Dijon, France.,Dijon University Hospital, Clinical investigation Center, Clinical epidemiology/clinical trials unit, Dijon, France.,Eye and Nutrition Research group, CSGA, UMR 1324 INRA, Dijon, France
| | - Arthur Azemar
- Cardiology Department, University Hospital, Dijon, France
| | | | - Maud Maza
- PEC 2, Univ. Bourgogne Franche-Comté, Dijon, France
| | | | | | - Pierre-Henri Gabrielle
- Ophthalmology Department, University Hospital, Dijon, France.,Eye and Nutrition Research group, CSGA, UMR 1324 INRA, Dijon, France
| | - Alain Marie Bron
- Ophthalmology Department, University Hospital, Dijon, France.,Eye and Nutrition Research group, CSGA, UMR 1324 INRA, Dijon, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, Dijon, France.,Eye and Nutrition Research group, CSGA, UMR 1324 INRA, Dijon, France
| | - Yves Cottin
- Cardiology Department, University Hospital, Dijon, France.,PEC 2, Univ. Bourgogne Franche-Comté, Dijon, France
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9
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Pickering JW, Blunt IRH, Than MP. Acute Kidney Injury and mortality prognosis in Acute Coronary Syndrome patients: A meta-analysis. Nephrology (Carlton) 2018; 23:237-246. [PMID: 27990707 DOI: 10.1111/nep.12984] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 01/06/2023]
Abstract
AIM The aim of this study is to provide a robust estimate of mortality risk in acute coronary syndrome (ACS)-associated acute kidney injury (AKI) to inform clinical practice and policy. METHODS A meta-analysis of cohort studies evaluating outcomes of ACS and which reported AKI and AKI-associated mortality. Studies were excluded if they incorporated patients not admitted through the emergency department (i.e. for elective procedures), were limited to cardiogenic shock or cardiac arrest, or relied on registry data for outcomes without further adjudication. The predictor was ACS-associated AKI and outcomes early (30 day or in-hospital) mortality and late-mortality (post-hospital discharge). RESULTS Thirty-six studies with 37 unique cohorts comprising 100 476 patients were included. The pooled rate of ACS-associated AKI was 15.8%. In 32 cohorts reporting early mortality, the crude early mortality rate was 15.0% amongst those with AKI compared with 2.0% amongst those without AKI. The pooled estimate of the relative risk of AKI-associated early mortality was 4.1 (95% confidence interval: 3.3 to 5.0) with high heterogeneity between studies (I 2 = 84% (61% to 88%)). When heterogeneity was accounted for mathematically using credibility ceilings, the risk of mortality was lower, but still clinically significant (3.1 (2.6 to 3.6)). In 19 cohorts reporting late mortality (1 to 10 years), the relative risk of AKI-associated mortality was 2.6 (2.0 to 3.3) with moderate heterogeneity (I 2 = 65 % [35% to 88%]). Following application of credibility ceiling relative risk estimate dropped to 2.2 (1.9 to 2.6). CONCLUSIONS Acute coronary syndrome-associated AKI is associated with more than a three-fold increase in early mortality and more than two-fold in long-term mortality.
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Affiliation(s)
- John W Pickering
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.,Emergency Department, Christchurch hospital, Christchurch, New Zealand
| | | | - Martin P Than
- Emergency Department, Christchurch hospital, Christchurch, New Zealand
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10
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The Incidence and the Prognostic Impact of Acute Kidney Injury in Acute Myocardial Infarction Patients: Current Preventive Strategies. Cardiovasc Drugs Ther 2018; 32:81-98. [DOI: 10.1007/s10557-017-6766-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Ortega-Hernández J, Springall R, Sánchez-Muñoz F, Arana-Martinez JC, González-Pacheco H, Bojalil R. Acute coronary syndrome and acute kidney injury: role of inflammation in worsening renal function. BMC Cardiovasc Disord 2017; 17:202. [PMID: 28747177 PMCID: PMC5530514 DOI: 10.1186/s12872-017-0640-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/20/2017] [Indexed: 12/21/2022] Open
Abstract
Background Acute Kidney Injury (AKI), a common complication of acute coronary syndromes (ACS), is associated with higher mortality and longer hospital stays. The role of cytokines and other mediators is unknown in AKI induced by an ACS (ACS-AKI), leading to several unanswered questions. The worsening of renal function is usually seen as a dichotomous phenomenon instead of a dynamic change, so evaluating changes of the renal function in time may provide valuable information in the ACS-AKI setting. The aim of this study was to explore inflammatory factors associated to de novo kidney injury induced by de novo cardiac injury secondary to ACS. Methods One hundred four consecutive patients with ACS were initially included on the time of admission to the Coronary Unit of the Instituto Nacional de Cardiología in Mexico City, from February to May 2016, before any invasive procedure, imaging study, diuretic or anti-platelet therapy. White blood count, hemoglobin, NT-ProBNP, troponin I, C-reactive protein, albumin, glucose, Na+, K+, blood urea nitrogen (BUN), total cholesterol, HDL, LDL, triglycerides, creatinine (Cr), endothelin-1 (ET-1), leukotriene-B4, matrix metalloproteinase-2 and -9, tissue inhibitor of metalloproteinases-1, resolvin-D1 (RvD1), lipoxin-A4 (LXA4), interleukin-1β, −6, −8, and −10 were measured. We finally enrolled 78 patients, and subsequently we identified 15 patients with ACS-AKI. Correlations were obtained by a Spearman rank test. Low-rank regression, splines regressions, and also protein–protein/chemical interactions and pathways analyses networks were performed. Results Positive correlations of ΔCr were found with BUN, admission Cr, GRACE score, IL-1β, IL-6, NT-ProBNP and age, and negative correlations with systolic blood pressure, mean-BP, diastolic-BP and LxA4. In the regression analyses IL-10 and RvD1 had positive non-linear associations with ΔCr. ET-1 had also a positive association. Significant non-linear associations were seen with NT-proBNP, admission Cr, BUN, Na+, K+, WBC, age, body mass index, GRACE, SBP, mean-BP and Hb. Conclusion Inflammation and its components play an important role in the worsening of renal function in ACS. IL-10, ET-1, IL-1β, TnI, RvD1 and LxA4 represent mediators that might be associated with ACS-AKI. IL-6, ET-1, NT-ProBNP might represent crossroads for several physiopathological pathways involved in “de novo cardiac injury leading to de novo kidney injury”. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0640-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jorge Ortega-Hernández
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico.,Faculty of Medicine, Universidad Nacional Autónoma de Mexico, Avenida Universidad 3000, Copilco-Universidad, 04510, Mexico City, Mexico
| | - Rashidi Springall
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Fausto Sánchez-Muñoz
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico
| | - Julio-C Arana-Martinez
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico.,Department of Health Care, Universidad Autónoma Metropolitana Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960, Mexico City, Mexico
| | - Héctor González-Pacheco
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, 14080, Mexico City, Mexico
| | - Rafael Bojalil
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, 14080, Mexico City, Mexico. .,Department of Health Care, Universidad Autónoma Metropolitana Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960, Mexico City, Mexico.
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Simplifying contrast-induced acute kidney injury prediction after primary percutaneous coronary intervention: the age, creatinine and ejection fraction score. Cardiovasc Interv Ther 2017; 33:224-231. [DOI: 10.1007/s12928-017-0472-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/17/2017] [Indexed: 12/15/2022]
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13
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Liu YH, Jiang L, Duan CY, He PC, Liu Y, Tan N, Chen JY. Canada Acute Coronary Syndrome Score: A Preprocedural Risk Score for Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention. Angiology 2017; 68:782-789. [PMID: 28135823 DOI: 10.1177/0003319717690674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention, contrast-induced nephropathy (CIN) is a serious complication associated with poor outcomes. We assessed the predictive value of the Canada Acute Coronary Syndrome (C-ACS) score for CIN in these patients. A total of 394 consecutive patients with STEMI were enrolled and divided into 3 groups according to their C-ACS scores—group 1, score 0; group 2, score 1; and group 3, score ≥2. The clinical outcomes were CIN and major adverse clinical events (MACEs) during hospital and follow-up; 8.4% of patients developed CIN. Patients with high C-ACS scores were more likely to develop CIN, in-hospital death, and MACEs ( P < .001). The C-ACS score was an independent predictor of CIN (odds ratio = 2.87; 95% confidence interval = 1.78-4.63; P < .001) and risk factor for long-term MACEs. The C-ACS score had good predictive values for CIN, in-hospital morality, MACEs, and long-term mortality. Patients with high C-ACS risk scores exhibited a worse survival rate than those with low scores (death, P = .02; MACEs, P = .006). In conclusion, in patients with STEMI, the C-ACS could predict CIN and clinical outcomes.
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Affiliation(s)
- Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
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Lazaros G, Zografos T, Oikonomou E, Siasos G, Georgiopoulos G, Vavuranakis M, Antonopoulos A, Kalogeras K, Tsalamandris S, Tousoulis D. Usefulness of C-Reactive Protein as a Predictor of Contrast-Induced Nephropathy After Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction and Presentation of a New Risk Score (Athens CIN Score). Am J Cardiol 2016; 118:1329-1333. [PMID: 27745963 DOI: 10.1016/j.amjcard.2016.07.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 01/09/2023]
Abstract
Contrast-induced nephropathy (CIN) after percutaneous coronary interventions (PCI) in patients with acute myocardial infarction (AMI) is associated with high morbidity and mortality, whereas there are no reliable predictive tools easy to use. We evaluated the association of pre-procedural high-sensitivity C-reactive protein (hsCRP) with the development of CIN and integrated this variable in a new risk CIN prediction model. Consecutive patients (348 AMI subjects) who underwent PCI were recruited. Creatinine levels were detected on admission, at 24, 48, and 72 hours after PCI. CIN was defined using the Kidney Disease: Improving Global Outcomes criteria. In our study population (348 subjects), CIN developed in 54 patients (15.5%). Patients with CIN were older and had higher hsCRP at admission, whereas their ejection fraction (EF) and glomerular filtration rate (GFR) were lower. In multivariate analysis after incorporating potential confounders, hsCRP at admission was an independent predictor of CIN (OR for logCRP 2.00, p = 0.01). In receiver-operating characteristic curve analysis, a model incorporating hsCRP, age, GFR, and EF showed good accuracy in predicting the development of CIN (c statistic 0.84, 95% confidence interval 0.793 to 0.879). A total risk score derived from the proposed model yielded significant positive and negative predictive values and classified 85.8% of our patients correctly for CIN. In conclusion, measuring hsCRP levels at admission in patients who underwent PCI for AMI may offer additional assistance in predicting the development of CIN. A model incorporating age and admission hsCRP, EF, and GFR emerged as an accurate tool for predicting CIN in this context.
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Zhao SJ, Zhong ZS, Qi GX, Tian W. The efficacy of N-acetylcysteine plus sodium bicarbonate in the prevention of contrast-induced nephropathy after cardiac catheterization and percutaneous coronary intervention: A meta-analysis of randomized controlled trials. Int J Cardiol 2016; 221:251-9. [DOI: 10.1016/j.ijcard.2016.07.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/04/2016] [Indexed: 01/16/2023]
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Does N-terminal pro-brain natriuretic peptide add prognostic value to the Mehran risk score for contrast-induced nephropathy and long-term outcomes after primary percutaneous coronary intervention? Int Urol Nephrol 2016; 48:1675-82. [PMID: 27473154 DOI: 10.1007/s11255-016-1348-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the prognostic value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) in relation to Mehran risk score (MRS) for contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS We prospectively enrolled 283 consecutive patients treated with PPCI for STEMI. NT-proBNP was measured, and the MRS was calculated. The primary end point was CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL from baseline within 48-72 h after contrast medium exposure. RESULTS The incidence of CIN was 9.2 %. Patients with CIN had higher NT-proBNP and MRS than those without CIN. The value of NT-proBNP was similar to MRS for CIN (C statistics 0.760 vs. 0.793, p = 0.689). After adjustment for MRS, elevated NT-proBNP (defined as the best cutoff point) was significantly associated with CIN. The addition of elevated NT-proBNP to MRS did not significantly improve the C statistics, over that with the original MRS model (0.833 vs. 0.793, p = 0.256). In addition, similar results were observed for in-hospital and long-term major adverse clinical events. CONCLUSIONS Although NT-proBNP did not add any prognostic value to the MRS model for CIN, NT-proBNP, as a simple biomarker, was similar to MRS, and may be another useful and rapid screening tool for CIN and death risk assessment, identifying subjects who need therapeutic measures to prevent CIN.
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Comparison of Different Risk Scores for Predicting Contrast Induced Nephropathy and Outcomes After Primary Percutaneous Coronary Intervention in Patients With ST Elevation Myocardial Infarction. Am J Cardiol 2016; 117:1896-903. [PMID: 27161818 DOI: 10.1016/j.amjcard.2016.03.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 02/03/2023]
Abstract
Accurate risk stratification for contrast-induced nephropathy (CIN) is important for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We aimed to compare the prognostic value of validated risk scores for CIN. We prospectively enrolled 422 consecutive patients with STEMI undergoing PPCI. Mehran; Gao; Chen; age, serum creatinine (SCr), or glomerular filtration rate, and ejection fraction (ACEF or AGEF); and Global Registry for Acute Coronary Events risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (increase in SCr ≥0.5 mg/dl) or CIN broad (≥0.5 mg/dl and/or a ≥25% increase in baseline SCr). All risk scores had relatively high predictive values for CIN-narrow (c-statistic: 0.746 to 0.873) and performed well for prediction of in-hospital death (0.784 to 0.936), MACEs (0.685 to 0.763), and 3-year all-cause mortality (0.655 to 0.871). The ACEF and AGEF risk scores had better discrimination and calibration for CIN-narrow and in-hospital outcomes. However, all risk score exhibited low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). In conclusion, risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in patients with STEMI undergoing PPCI. The ACEF and AGEF risk scores appear to have greater prognostic value.
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Liu YH, Liu Y, Zhou YL, Yu DQ, He PC, Xie NJ, Li HL, Wei-Guo, Chen JY, Tan N. Association of N-terminal pro-B-type natriuretic peptide with contrast-induced nephropathy and long-term outcomes in patients with chronic kidney disease and relative preserved left ventricular function. Medicine (Baltimore) 2015; 94:e358. [PMID: 25837748 PMCID: PMC4554022 DOI: 10.1097/md.0000000000000358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The aim of the present article was to evaluate the association of N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) with contrast-induced nephropathy (CIN) and long-term outcomes in patients with chronic kidney disease (CKD) and relative preserved left ventricular function (LVF) undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 1203 consecutive patients with CKD and preserved LVF undergoing elective PCI. The primary end point was the development of CIN, defined as an absolute increase in serum creatinine (SCr) ≥0.5 mg/dL, from baseline within 48 to 72 hours after contrast medium exposure. CIN incidence varied from 2.2% to 5.2%. Univariate logistic analysis showed that lg-NT-pro-BNP was significantly associated with CIN (odds ratio [OR] = 3.93, 95% confidence interval [CI], 2.22-6.97, P < 0.001). Furthermore, lg-NT-pro-BNP remained a significant predictor of CIN (OR = 3.30, 95% CI, 1.57-6.93, P = 0.002), even after adjusting for potential confounding risk factors. These results were confirmed by using other CIN criteria, which were defined as elevations of the SCr by 25% or 0.5 and 0.3 mg/dL from the baseline. The best cutoff value of lg-NT-pro-BNP for detecting CIN was 2.73 pg/mL (537 pg/mL) with 73.1% sensitivity and 70.0% specificity according to the receiver operating characteristic (ROC) analysis (C statistic = 0.754, 95% CI, 0.67-0.84, P < 0.001). In addition, NT-pro-BNP ≥537 pg/mL (2.73 pg/mL, lg-NT-pro-BNP) was associated with an increased risk of all-cause mortality and composite end points during 2.5 years of follow-up. NT-pro-BNP ≥537 pg/mL is independently associated with an increased risk of CIN with different definitions and poor clinical outcomes in patients with CKD and relative preserved LVF undergoing PCI.
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Affiliation(s)
- Yuan-hui Liu
- From the Department of Cardiology (Y-hL, YL, Y-lZ, D-qY, P-cH, N-JX, H-lL, W-G, J-yC, NT), Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences; and Southern Medical University (Y-hL), Guangzhou, Guangdong, China
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Comparison of the efficacy of rosuvastatin versus atorvastatin in preventing contrast induced nephropathy in patient with chronic kidney disease undergoing percutaneous coronary intervention. PLoS One 2014; 9:e111124. [PMID: 25357250 PMCID: PMC4214705 DOI: 10.1371/journal.pone.0111124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/19/2014] [Indexed: 01/03/2023] Open
Abstract
Objectives We prospectively compared the preventive effects of rosuvastatin and atorvastatin on contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Methods We enrolled 1078 consecutive patients with CKD undergoing elective PCI. Patients in Group 1 (n = 273) received rosuvastatin (10 mg), and those in group 2 (n = 805) received atorvastatin (20 mg). The primary end-point was the development of CIN, defined as an absolute increase in serum creatinine ≥0.5 mg/dL, or an increase ≥25% from baseline within 48–72 h after contrast medium exposure. Results CIN was observed in 58 (5.4%) patients. The incidence of CIN was similar in patients pretreated with either rosuvastatin or atorvastatin (5.9% vs. 5.2%, p = 0.684). The same results were also observed when using other definitions of CIN. Clinical and procedural characteristics did not show significant differences between the two groups (p>0.05). Additionally, there were no significant inter-group differences with respect to in-hospital mortality rates (0.4% vs. 1.5%, p = 0.141), or other in-hospital complications. Multivariate logistic regression analysis revealed that rosuvastatin and atorvastatin demonstrated similar efficacies for preventing CIN, after adjusting for potential confounding risk factors (odds ratio = 1.17, 95% confidence interval, 0.62–2.20, p = 0.623). A Kaplan–Meier survival analysis showed that patients taking either rosuvastatin or atorvastatin had similar incidences of all-cause mortality (9.4% vs. 7.1%, respectively; p = 0.290) and major adverse cardiovascular events (29.32% vs. 23.14%, respectively; p = 0.135) during follow-up. Conclusions Rosuvastatin and atorvastatin have similar efficacies for preventing CIN in patients with CKD undergoing PCI.
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Liu YH, Liu Y, Chen JY, Zhou YL, Chen ZJ, Yu DQ, Luo JF, Li HL, He YT, Ye P, Ran P, Guo W, Tan N. LDL cholesterol as a novel risk factor for contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention. Atherosclerosis 2014; 237:453-9. [PMID: 25463073 DOI: 10.1016/j.atherosclerosis.2014.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/16/2014] [Accepted: 10/04/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Low density lipoprotein cholesterol (LDL-C) is associated with endothelial dysfunction, inflammation and increased vasoconstriction, which are involved in the development of contrast-induced acute kidney injury (CI-AKI). However, whether LDL-C is an independent risk factor of CI-AKI in patients undergoing percutaneous coronary intervention (PCI) is unknown. METHODS We prospectively enrolled 3236 consecutive patients undergoing PCI between January 2010 and September 2012. Multivariate logistic regression analysis was used to determine whether LDL-C is an independent risk factor of CI-AKI. CI-AKI was defined as an absolute increase in serum creatinine of ≥ 0.5 mg/dL or ≥ 25% over the baseline value within 48-72 h after contrast exposure. RESULTS CI-AKI was observed in 338 patients (10.4%). Patients with CI-AKI had a significantly higher rate of in hospital mortality (4.4% vs. 0.5%, p < 0.001), and significantly higher rates of other in hospital complications compared with those without CI-AKI. The LDL-C quartiles were as follows: Q1 (<2.04 mmol/L), Q2 (2.04-2.61 mmol/L), Q3 (2.61-3.21 mmol/L) and Q4 (>3.21 mmol/L). Patients with high baseline LDL-C levels were more likely to develop CI-AKI and composite end points including all-cause mortality, renal replacement therapy, non-fatal myocardial infarction, acute heart failure, target vessel revascularization or cerebrovascular accident during the observation period of hospitalization (8.9%, 9.9%, 10.5%, 12.6%, p = 0.001, and 5.0%, 5.2%, 6.1%, 8.1%, respectively; p = 0.007). Univariate logistic analysis showed that LDL-C levels (increment 1 mmol/L) were significantly associated with CI-AKI (odds ratio = 1.25, 95% confidence interval (CI), 1.11-1.39, p < 0.001). Furthermore, LDL-C remained a significant risk factor of CI-AKI (odds ratio = 1.23, 95% CI, 1.04-1.45, p = 0.014), even after adjusting for potential confounding risk factors. CONCLUSIONS Measurement of plasma LDL-C concentrations in patients undergoing PCI may be helpful to identify those who are at risk of CI-AKI and poor in hospital outcomes.
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Affiliation(s)
- Yuan-hui Liu
- Southern Medical University, Guangzhou 510515, Guangdong, China; Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Zhu-jun Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Dan-qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Jian-fang Luo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Hua-long Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Yi-ting He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Piao Ye
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Peng Ran
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Wei Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, Guangdong, China.
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Liu YH, Liu Y, Duan CY, Tan N, Chen JY, Zhou YL, Li LW, He PC. Statins for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography/Percutaneous Interventions: A Meta-analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol Ther 2014; 20:181-92. [PMID: 25193735 DOI: 10.1177/1074248414549462] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Statins have been demonstrated to prevent the development of contrast-induced nephropathy (CIN). Nevertheless, clinical research has indicated conflicting results. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the protective effects of statins on CIN and the requirement of renal replacement therapy (RRT) in patients undergoing coronary angiography/percutaneous interventions. METHODS PubMed, MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central RCTs were searched for RCTs from inception to February 2014 to compare statins with placebo treatment for preventing CIN in patients undergoing coronary angiography/percutaneous interventions. RESULTS Nine RCTs were identified and analyzed in a total of 5143 patients involving 2560 patients with statin pretreatment and 2583 patients as control. Patients who received statin therapy had a 53% lower risk of CIN with different definitions (within 48 or 72 hours) compared to the control group based on a fixed effect model (risk ratio = 0.47, 95% confidence interval = 0.37-0.60, P < .0001) and were less likely to require RRT based on Peto fixed effect. Subgroup analysis showed that statin pretreatment could decrease the incidence of CIN in patients with preexisting renal dysfunction or diabetes mellitus. In addition, patients on rosuvastatin had a similar reduced incidence of CIN compared to patients on atorvastatin. CONCLUSION This updated meta-analysis demonstrated that preprocedural statin treatment could reduce the risk of CIN and the need for RRT in patients undergoing coronary angiography/percutaneous interventions. Moreover, statin therapy would be helpful in reducing the incidence of CIN in high-risk patients with preexisting renal dysfunction or diabetes mellitus. Additionally, rosuvastatin and atorvastatin had similar efficacies in preventing CIN development.
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Affiliation(s)
- Yuan-hui Liu
- Department of Graduate School, Southern Medical University, Guangzhou, Guangdong, China Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China These authors (Yuan-hui Liu, Yong Liu, Chong-yang Duan) contributed equally to this work
| | - Yong Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China These authors (Yuan-hui Liu, Yong Liu, Chong-yang Duan) contributed equally to this work
| | - Chong-yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, Chin These authors (Yuan-hui Liu, Yong Liu, Chong-yang Duan) contributed equally to this work
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ying-ling Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Li-wen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Peng-cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Yang K, Liu W, Ren W, Lv S. Different interventions in preventing contrast-induced nephropathy after percutaneous coronary intervention. Int Urol Nephrol 2014; 46:1801-7. [PMID: 24966097 DOI: 10.1007/s11255-014-0765-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/10/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study aimed to observe the preventive potential of different hydration solutions on contrast-induced nephropathy (CIN) after percutaneous coronary intervention. METHODS We initially screened 627 patients who were admitted to the Division of Cardiology, Beijing Anzhen Hospital between October 2010 and October 2011. The research subjects were randomly divided into four groups and were given: normal physiological saline (PS), sodium bicarbonate (SB), oral administration of PS + N-acetylcysteine (NAC) (PS + NAC), or oral administration of SB + NAC (SB + NAC). These patients were administered a hypotonic nonionic contrast agent, and the incidence of CIN in each group was observed. RESULTS The total incidence rate of CIN was 4.47 %, while the CIN incidence rates in the PS group, the SB group, the PS + NAC group and the SB + NAC group were 3.11, 5.03, 4.46 and 5.33 %, respectively. The differences between these groups were not statistically significant (P = 0.238), and for patients with diabetes and/or renal dysfunction, the incidence rates of CIN among the four groups did not show statistically significant differences (P = 0.238, 0.156, 0.287). CONCLUSION Use of PS, SB, and NAC caused no significant reduction in the incidence of CIN, but in high-risk patients with diabetes and/or renal dysfunction, SB + NAC might be superior to the application of isotonic crystalloid solution.
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Affiliation(s)
- Kun Yang
- Department of Coronary Care Unit (CCU), Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
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Li WH, Li DY, Qian WH, Liu JL, Xu TD, Zhu H, He HY. Prevention of contrast-induced nephropathy with prostaglandin E1 in high-risk patients undergoing percutaneous coronary intervention. Int Urol Nephrol 2014; 46:781-6. [PMID: 24570327 DOI: 10.1007/s11255-014-0674-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 02/13/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE Contrast-induced nephropathy (CIN) is an important complication in the use of iodinated contrast media. The present study aimed to assess the safety and efficacy of prostaglandin E1 (PGE1) in prevention of CIN in patients with high-risk factors undergoing percutaneous coronary intervention (PCI). METHODS The study group consisted of 163 patients who had undergone a coronary intervention procedure between January 1, 2012 and October 31, 2012. Study participants were randomly assigned to either the PGE1 group (82 patients) or the control group (81 patients). Patients in the PGE1 group received PGE1 intravenous infusion of 20 ng/kg/min for 6 h before and after the administration of contrast media. The control group received 0.9 % sodium chloride solution for routine hydration only. A nonionic, low-osmolality contrast agent was used in our laboratory at this time. Serum creatinine (Scr) values and estimated glomerular filtration rate were measured before and within 48 h of the administration of contrast agents. CIN was defined as an increase of ≥0.5 mg/dL or ≥ a 25 % increase in Scr concentrations over baseline within 48 h of angiography. RESULTS The amount of contrast agent administered was similar for the PGE1 and control groups (156 ± 63 vs. 161 ± 68 mL, P > 0.05). The incidence of CIN was lower in the PGE1 group than in the control group (3.7 vs. 11.1 %, P < 0.05). No serious adverse effects were observed. CONCLUSIONS In patients with high-risk factors undergoing PCI, the use of PGE1 for prevention of CIN is safe and efficacious.
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Affiliation(s)
- Wen-Hua Li
- Department of Cardiology, Affiliated Hospital of XuZhou Medical College, No. 99 Huaihai West Road, Xuzhou, 221002, China,
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