Association between high-sensitivity C-reactive protein and contrast-induced nephropathy after primary percutaneous coronary intervention
10.3760/cma.j.issn.0253-3758.2013.05.009
- VernacularTitle:高敏C反应蛋白与经皮冠状动脉介入治疗患者对比剂肾病的相关性
- Keywords:
C-reactive protein;
Contrast media;
Nephrosis;
Angioplasty,transluminal,pcrcutaneous coronary
- From:
Chinese Journal of Cardiology
2013;41(5):394-398
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the association between high-sensitivity C-reactive protein (hs-CRP) and contrast-induced nephropathy (CIN) in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI).Methods A total of 220 STEMI patients undergoing primary PCI from Guangdong general hospital were recruited.Patients were divided into four groups according to the quartile of hs-CRP(Q1 group:hs-CRP ＜ 6.26 mg/L,Q2 group:6.26-14.44 mg/L,Q3 group:14.45-33.08 mg/L,Q4 group:hs-CRP ＞ 33.08 mg/L).Baseline data,CIN incidence and other in-hospital outcomes were compared among groups.CIN was defined as an increase in serum creatinine of more than 5 mg/L from baseline within 48-72 hours after contrast media exposure.Receiver operator characteristics (ROC) curves and multivariate logistic regression were used to assessed the correlation between hs-CRP and CIN.Results CIN occurred in 21 (9.8％) patients.CIN incidence of hs-CRP quartitles were 1.8％(1/55),1.8％ (1/55),14.5％ (8/55) and 20.0％ (11/55) (P-trend ＜0.01),respectively.In-hospital death (P-trend ＞ 0.05),required renal replace therapy (P-trend ＞ 0.05) were similar among groups.ROC analysis revealed that the optimal cutoff value of hs-CRP to predict the onset of CIN was 16.85mg/L (sensitivity:81.0％,specificity:61.8％,AUC:0.748).Univariate logistic analysis showed that hs-CRP was strongly related with CIN incidence(OR =6.88,95％ CI:2.23-21.21,P ＜ 0.01).Multivariate logistic regression analysis showed that after adjusting other traditional risk factors including female gender,anemia,ACEI/ARB use,IABP support,LVEF ＜ 40％,age ＞ 75 years,baseline eGFR and diabetes,hs-CRP ＞ 16.85 mg/L was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI.Additionally,age ＞ 75 years (OR =7.27,95％ CI:1.85-28.63,P ＜ 0.01),eGFR (OR =6.38,95％ CI:1.48-27.41,P ＜0.05)were also independent risk factors of CIN.Conclusions hs-CRP is positively correlated with CIN incidence.STEMI patients with higher hs-CRP level post PCI is at higher risk of developing CIN.
