[Contrast-induced acute kidney injury]

An Evaluation of a Point-of-Care GEM Premier ChemSTAT Analyzer in an Emergency Department: Prevention of Contrast-Induced Nephropathy and Optimization of Patient Flow

Background: Having a laboratory renal profile for medical imaging examinations requiring contrast media (CM) administration is strongly advised. Creatinine helps identify patients at risk of contrast-induced nephropathy (CIN). The GEM® Premier™ ChemSTAT (Werfen) is a point-of-care (POC) analyzer with 12 emergency parameters, including a creatinine assay. This study aims to compare ChemSTAT with the central analytical solution of the University Hospital of Clermont-Ferrand and to evaluate the interest in using POC creatinine in the emergency department (ED) to optimize the flow of patients, especially when CM administration is necessary. Methods: More than 200 whole blood (WB) samples from the ED were evaluated on the ChemSTAT analyzer. As comparative methods, the plasma aliquots from the same samples were assayed on an Atellica® CH (Siemens Healthineers). The clinical concordance was assessed according to the decision cut-offs of the French Society of Radiology for the risk of CIN. The availability times of biological results between ChemSTAT and the central laboratory were studied. Results: WB results from the ChemSTAT analyzer correlated well with those from the Atellica® CH, except for tCO2 (the known bias between the Siemens and Cobas Roche methods for predicting ChemSTAT values). The results of the creatinine assay allow for identical medical decisions in comparison to the renal-risk cut-offs. The availability of the biological results was reduced by 50 min on average with ChemSTAT vs the central laboratory. Computed tomography (CT) was performed for 44.7% of patients, including the injection of the CM in 68% of cases. For these patients, the availability of creatinine results relative to imaging time is faster with the ChemSTAT by an average of 45.2 min. Conclusions: Great analytical and clinical correlations for creatinine assays allow for the safe identification of patients at risk of CIN, and improve patient flow in ED, especially for those requiring computed tomography with CM.

Dynamic Changes in the Renal Function of Acute Myocardial Infarction Patients with Reduced eGFR After Emergency Percutaneous Coronary Intervention

Renal dysfunction greatly influences decision-making for emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). This observational study investigated renal function changes and risk factors for renal injury in patients with AMI with reduced estimated glomerular filtration rate (eGFR) who underwent emergency PCI. The study included 85 patients with AMI with decreased eGFR who underwent emergency PCI, categorized into stage 2, 3, and 4 chronic kidney disease groups. Baseline data, laboratory indicators, coronary characteristics, and serum creatinine concentration were monitored at multiple time points. Renal injury was defined using two criteria: an increase in serum creatinine level by 0.3 mg/dL or a 50% increase from baseline. During the 1-year follow-up, renal injury incidence varied from 1.18% to 15.29%. The pattern showed an increasing trend in the 1st week after PCI, peaking at 1 week, followed by a decrease at 3 months, and another increase at one year. Low basal eGFR, high contrast agent dosage, and diabetes were associated with renal injury according to logistic regression analysis. The eGFR cutoff value of 35.475 mL/minute·1.73 m2 had a sensitivity of 83.05% and specificity of 57.69% for predicting renal injury based on receiver operating characteristic curve analysis. In summary, patients with AMI with basal eGFR lower than 35.475 mL/minute·1.73 m2 have a higher risk of renal injury after PCI. These findings emphasize the importance of assessing renal function and considering associated risk factors when deciding on emergency PCI for AMI with reduced eGFR.