Sahin Irfan, Karabulut Ahmet, Avci Ilhan Iker, Okuyan Ertugrul, Biter Halil I, Yildiz Suleyman S, Can Mehmet M, Gungor Baris, Dinckal Mustafa, Serebruany Victor
aDepartment of Cardiology, Bagcilar Public Education and Research Hospital bDepartment of Cardiology, Istanbul Medicine Hospital cDepartment of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey dJohns Hopkins University, Baltimore, Maryland, USA.
Blood Coagul Fibrinolysis. 2015 Apr;26(3):246-9. doi: 10.1097/MBC.0000000000000107.
Contrast-induced nephropathy (CIN) accounts for 10% of hospital-acquired renal failure, causes a prolonged in-hospital stay and represents a powerful predictor of poor clinical outcome. The underlying mechanism of the CIN development remains unclear and seems to be multifactorial. The potential link between platelet indices such as mean platelet volume (MPV) and platelet distribution width (PDW) with CIN is unknown. Herein, we aimed to investigate the correlation between MPV and PDW levels with the development of CIN. The incidence of CIN (20.5%) was prospectively evaluated in 430 patients with diagnosis of acute coronary syndrome. Initial creatinine (1.13 ± 0.25 vs. 1.05 ± 0.27 mg/dl, P = 0.01) and PDW (40.1 ± 20.2 vs. 34.5 ± 19.9%, P = 0.02) levels and the total volume of contrast media used (121 ± 61 vs. 94 ± 42 ml, P = 0.01) were higher in patients who developed CIN. MPV was similar between the two groups (P = 0.80). In a univariate regression analysis, age, increased creatinine, uric acid, phosphate, PDW levels and higher total volume of contrast media used were significantly correlated with CIN incidence. However, in a multivariate analysis, only total volume of CM used [odds ratio (OR) 1.011, 95% confidence interval (CI) 1.006-1.016; P = 0.01], increased age (OR 1.026, 95% CI 1.00-1.052; P = 0.05) and increased PDW levels (OR 1.009, 95% CI 1.00-1.022; P = 0.04) remained as the independent predictors of CIN. Among platelet indices, PDW, but not MPV, was associated with CIN development. The clinical significance of such link remains unclear, but may indicate involvement of platelet activation in CIN pathogenesis.
对比剂肾病（CIN）占医院获得性肾衰竭的10%，导致住院时间延长，是临床预后不良的有力预测指标。CIN发生的潜在机制尚不清楚，似乎是多因素的。血小板指标如平均血小板体积（MPV）和血小板分布宽度（PDW）与CIN之间的潜在联系尚不清楚。在此，我们旨在研究MPV和PDW水平与CIN发生之间的相关性。对430例诊断为急性冠状动脉综合征的患者进行前瞻性评估CIN的发生率。发生CIN的患者初始肌酐水平（1.13±0.25 vs. 1.05±0.27mg/dl，P = 0.01）、PDW水平（40.1±20.2 vs. 34.5±19.9%，P = 0.02）以及使用的造影剂总量（121±61 vs. 94±42ml，P = 0.01）更高。两组之间的MPV相似（P = 0.80）。在单因素回归分析中，年龄、肌酐升高、尿酸、磷酸盐、PDW水平以及使用的造影剂总量增加与CIN发生率显著相关。然而，在多因素分析中，只有使用的造影剂总量[比值比（OR）1.011，95%置信区间（CI）1.006 - 1.016；P = 0.01]、年龄增加（OR 1.026，95% CI 1.00 - 1.052；P = 0.05）和PDW水平升高（OR 1.009，95% CI 1.00 - 1.022；P = 0.04）仍然是CIN的独立预测因素。在血小板指标中，与CIN发生相关的是PDW，而非MPV。这种联系的临床意义尚不清楚，但可能表明血小板激活参与了CIN的发病机制。
