Author + information
- Tuo Zhang,
- Weifeng Zhang,
- Shiqun Sun,
- Xiaolei Wang,
- Linghong Shen and
- Ben He
Contrast-induced acute kidney injury (CI-AKI), a powerful predictor of unfavorable long-term prognosis, was traditionally defined as an increase of serum creatinine (sCr) after contrast media (CM) exposure. Recently, serum cystatin C (sCyC) had been proposed as an alternative to sCr to detect acute changes in renal function. However, the increment cut-off point of sCyC to detect CI-AKI and the clinical implication of combining sCyC and sCr as new definition of CI-AKI remains to be further elucidated.
1071 consecutive patients undergoing coronary angiography/intervention from July 1, 2013 to August 31, 2014 were prospectively included. Patients requiring dialysis were excluded. sCyC and sCr were assessed at baseline and 24-48 hours after CM exposure. CI-AKItraditional was defined as a sCr increase ≥0.3mg/dL or 50% from baseline. Major adverse events (MAEs, including death, myocardial infarction, stoke, revascularization and dialysis) at 12 months were assessed.
CI-AKItraditional developed in 25 patients (2.3%). 12 month follow-up was available in 1063 patients (99.2%) and MAEs occurred in 61 patients (5.7%). By receiver operating characteristic curve analysis, a sCyC increase≥15% was the optimal increment cut-off value for CI-AKI detection with a 80% sensitivity and 83% specificity and occurred in 187 patients (17.4%). Patients with a sCyC increase≥15% had a higher Mehran score (5.2±3.9 vs 4.4±3.4, p=0.004) and incidence of MAEs (12.4% vs 4.3%, p<0.001). By multivariate logistic regression analysis, a sCyC increase≥15% was a significant predictor of MAEs at 12 month (adjusted odds ratio [OR] =3.04; 95% confidence interval [CI], 1.75 to 5.29; p<0.001). Using the composite of sCyC (increase≥15% as positive, +) and sCr (increase≥0.3mg/dL or 50% as positive, +) as CI-AKInew, compared with patients without any positive, patients with single-positive (sCyC+/sCr- or sCyC-/sCr+) and dual-positive (sCyC+/sCr+) were significantly associated with MASs at 12 month (adjusted OR: 2.06 [1.14, 3.71], p=0.017; 13.36 [3.65, 48.94], p<0.001, respectively).
sCyC is a reliable biomarker for CI-AKI detection and using the new definition of CI-AKI by the composite of sCyC and sCr would be helpful to identify patients in danger of CI-AKI and risk stratification.