Reichetzeder Christoph, Heunisch Fabian, Einem Gina von, Tsuprykov Oleg, Kellner Karl-Heinz, Dschietzig Thomas, Kretschmer Axel, Hocher Berthold
Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany.
Center for Cardiovascular Research, Berlin, Germany.
Kidney Blood Press Res. 2017;42(2):244-256. doi: 10.1159/000477222. Epub 2017 May 25.
BACKGROUND/AIMS: Contrast induced acute kidney injury (CI-AKI) remains a serious complication of contrast media enhanced procedures like coronary angiography. There is still a lack of established biomarkers that help to identify patients at high risk for short and long-term complications. The aim of the current study was to evaluate plasma kynurenine as a predictive biomarker for CI-AKI and long-term complications, measured by the combined endpoint "major adverse kidney events" (MAKE) up to 120 days after CM application.
In this prospective cohort study 245 patients undergoing coronary angiography were analyzed. Blood samples were obtained at baseline, 24h and 48h after contrast media (CM) application to diagnose CI-AKI. Patients were followed for 120 days for adverse clinical events including death, the need for dialysis, and a doubling of plasma creatinine. Occurrence of any of these events was summarized in the combined endpoint MAKE.
Preinterventional plasma kynurenine was not associated with CI-AKI. Patients who later developed MAKE displayed significantly increased preinterventional plasma kynurenine levels (p<0.0001). ROC analysis revealed that preinterventional kynurenine is highly predictive for MAKE (AUC=0.838; p<0.0001). The optimal cutoff was found at ≥3.5 µmol/L Using this cutoff, the Kaplan-Meier estimator demonstrated that concentrations of plasma kynurenine ≥3.5 µmol/L were significantly associated with a higher prevalence of MAKE until follow up (p<0.0001). This association remained significant in multivariate Cox regression models adjusted for relevant factors of long-term renal outcome.
Preinterventional plasma kynurenine might serve as a highly predictive biomarker for MAKE up to 120 days after coronary angiography.
背景/目的：造影剂诱导的急性肾损伤（CI-AKI）仍然是冠状动脉造影等造影剂增强检查的严重并发症。目前仍缺乏能够帮助识别短期和长期并发症高危患者的成熟生物标志物。本研究的目的是评估血浆犬尿氨酸作为CI-AKI和长期并发症的预测生物标志物，通过造影剂应用后120天的综合终点“主要不良肾脏事件”（MAKE）来衡量。
在这项前瞻性队列研究中，分析了245例行冠状动脉造影的患者。在基线、造影剂（CM）应用后24小时和48小时采集血样以诊断CI-AKI。对患者进行120天的随访，观察不良临床事件，包括死亡、透析需求和血浆肌酐翻倍。这些事件中的任何一项发生情况汇总在综合终点MAKE中。
介入前血浆犬尿氨酸与CI-AKI无关。后来发生MAKE的患者介入前血浆犬尿氨酸水平显著升高（p<0.0001）。ROC分析显示，介入前犬尿氨酸对MAKE具有高度预测性（AUC=0.838；p<0.0001）。最佳截断值为≥3.5 μmol/L。使用该截断值，Kaplan-Meier估计显示，直到随访时，血浆犬尿氨酸浓度≥3.5 μmol/L与MAKE的较高患病率显著相关（p<0.0001）。在针对长期肾脏结局的相关因素进行调整的多变量Cox回归模型中，这种关联仍然显著。
介入前血浆犬尿氨酸可能作为冠状动脉造影后120天内MAKE的高度预测生物标志物。
