通过对接受冠状动脉造影患者术后早期尿生物标志物和肾内多普勒血流指数进行分析来预测造影剂诱导的急性肾损伤

Prediction of contrast-induced acute kidney injury by early post-procedural analysis of urinary biomarkers and intra-renal Doppler flow indices in patients undergoing coronary angiography.

作者信息

Wybraniec Maciej T, Chudek Jerzy, Bożentowicz-Wikarek Maria, Mizia-Stec Katarzyna

机构信息

First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Public Hospital No. 7 in Katowice - Upper Silesia Medical Centre, Katowice, Poland.

Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.

出版信息

J Interv Cardiol. 2017 Oct;30(5):465-472. doi: 10.1111/joic.12404. Epub 2017 Jul 6.

DOI:10.1111/joic.12404

PMID:28685874

Abstract

BACKGROUND

The study was designed to evaluate the applicability of combined assessment of urinary biomarkers and intra-renal Doppler flow indices for the prediction of contrast-induced acute kidney injury (CI-AKI) after coronary angiography/percutaneous coronary interventions (CA/PCI).

METHODS

This prospective observational study covered 95 consecutive patients with coronary artery disease subject to elective or urgent CA/PCI. Doppler intra-renal flow indices were assessed before and 1 h following CA/PCI. Urine samples were collected within 24 h before and 6 h after CA/PCI and assayed for urinary interleukin-18 (IL-18), liver-fatty acid-binding protein (L-FABP), and kidney injury molecule-1 (KIM-1) using ELISA method. CI-AKI was defined as ≥50% relative or ≥0.3 mg/dL absolute increase of serum creatinine concentration at 48 h post-procedurally.

RESULTS

CI-AKI was confirmed in nine patients (9.5%). CI-AKI onset was associated with significantly higher urinary KIM-1 at 6 h (P = 0.003) and ΔKIM-1 concentrations (P = 0.001), and urinary IL-18 at 6 h (P = 0.014) and ΔIL-18 concentrations (P = 0.012), however, L-FABP and ΔL-FABP levels were comparable in both groups. Receiver operating characteristic curve analysis denoted that post-procedural IL-18 levels at 6 h >89.8 pg/mg (AUC = 0.75, P = 0.007), KIM-1 at 6 h >0.425 ng/mg (AUC = 0.81, P = 0.001), renal resistive index (RRI) at 1 h >0.73 (AUC 0.88; P < 0.0001), and renal pulsatility index (RPI) at 1 h >0.86 (AUC = 0.86; P < 0.0001) predicted CI-AKI onset. Logistic regression analysis of postoperative predictors revealed that IL-18 and RRI were independent predictors of CI-AKI onset (AUC = 0.96; P < 0.0001).

CONCLUSIONS

Joint assessment of early post-procedural urinary biomarkers and Doppler renovascular parameters aids early diagnosis of CI-AKI in patients undergoing coronary interventions.

摘要

背景

本研究旨在评估联合检测尿生物标志物和肾内多普勒血流指数在预测冠状动脉造影/经皮冠状动脉介入治疗（CA/PCI）后对比剂诱导的急性肾损伤（CI-AKI）中的适用性。

方法

这项前瞻性观察性研究纳入了95例连续接受择期或急诊CA/PCI的冠心病患者。在CA/PCI术前及术后1小时评估肾内多普勒血流指数。在CA/PCI术前24小时内及术后6小时内收集尿液样本，采用酶联免疫吸附测定法（ELISA）检测尿白细胞介素-18（IL-18）、肝脂肪酸结合蛋白（L-FABP）和肾损伤分子-1（KIM-1）。CI-AKI定义为术后48小时血清肌酐浓度相对升高≥50%或绝对升高≥0.3mg/dL。

结果

9例患者（9.5%）确诊为CI-AKI。CI-AKI的发生与术后6小时尿KIM-1水平显著升高（P = 0.003）及KIM-1浓度变化值（P = 0.001）、术后6小时尿IL-18水平显著升高（P = 0.014）及IL-18浓度变化值（P = 0.012）相关，然而，两组间L-FABP及L-FABP浓度变化值水平相当。受试者工作特征曲线分析表明，术后6小时IL-18水平>89.8 pg/mg（AUC = 0.75，P = 0.007）、术后6小时KIM-1水平>0.425 ng/mg（AUC = 0.81，P = 0.001）、术后1小时肾阻力指数（RRI）>0.73（AUC = 0.88；P < 0.0001）及术后1小时肾搏动指数（RPI）>0.86（AUC = 0.86；P < 0.0001）可预测CI-AKI的发生。术后预测因素的逻辑回归分析显示，IL-18和RRI是CI-AKI发生的独立预测因素（AUC = 0.96；P < 0.0001）。