生长分化因子-15 水平与接受介入治疗的急性心肌梗死患者对比剂诱导急性肾损伤风险的关系：倾向评分匹配分析。

Growth differentiation factor-15 levels and the risk of contrast induced acute kidney injury in acute myocardial infarction patients treated invasively: A propensity-score match analysis.

机构信息

Department of Cardiology, Changzhou No.2 people's Hospital, Affiliated to Nanjing Medical University, Changzhou, China.

出版信息

PLoS One. 2018 Mar 12;13(3):e0194152. doi: 10.1371/journal.pone.0194152. eCollection 2018.

DOI:10.1371/journal.pone.0194152

PMID:29529072

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5846798/

Abstract

BACKGROUND

Growth differentiation factor-15 (GDF-15) is an emerging biomarker for risk stratification in cardiovascular disease. Contrast-induced acute kidney injury (AKI) is an important complication in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). In this retrospectively observational study, we aimed to determine the role of GDF-15 and the risk of AKI in acute myocardial infarction (AMI) patients.

METHODS

The medical records of 1195 patients with AMI were reviewed. After exclusion criteria, a total of 751 eligible patients who underwent CAG or PCI were studied. Preoperative clinical parameters including GDF-15 levels were recorded. Multivariate logistic regression analysis was used to identify the risk factors of AKI. Subsequently, to reduce a potential selection bias and to balance differences between the two groups, a propensity score-matched analysis was performed. We recorded the 30-day all-cause mortality of the total study population. Kaplan-Meier analysis was performed to identify the association between short term survival in AMI patients and GDF-15 level.

RESULTS

Among 751 enrolled patients, 106 patients (14.1%) developed AKI. Patients were divided into two groups: AKI group (n = 106) and non-AKI group (n = 645). GDF-15 levels were significantly higher in AKI group compared to non-AKI group (1328.2 ± 349.7 ng/L vs. 1113.0 ± 371.3 ng/L, P <0.001). Multivariate logistic regression analyses showed GDF-15 was an independent risk factor of AKI (per 1000 ng/L increase of GDF-15, OR: 3.740, 95% CI: 1.940-7.207, P < 0.001). According to GDF-15 tertiles, patients were divided into three groups. Patients in middle (OR 2.93, 95% CI: 1.46-5.89, P = 0.003) and highest GDF-15 tertile (OR 3.72, 95% CI: 1.87-7.39, P <0.001) had higher risk of AKI compared to patients in the lowest GDF-15 tertile. The propensity score-matched group set comprised of 212 patients. Multivariate logistic regression revealed that GDF-15 is still an independent risk factor for AKI after matching (per 1000 ng/L increase of GDF-15, OR: 2.395, 95% CI: 1.020-5.626, P = 0.045). Based on the Kaplan-Meier analysis, the risk of 30-day all-cause mortality increased in higher GDF-15 tertiles log rank chi-square: 29.895, P <0.001).

CONCLUSION

This suggests that preoperative plasma GDF-15 is an independent risk factor of AKI in AMI patients underwent CAG or PCI. GDF-15 and AKI are associated with poor short term survival of AMI patients.

摘要

背景

生长分化因子 15（GDF-15）是心血管疾病风险分层的新兴生物标志物。对比剂诱导的急性肾损伤（AKI）是接受冠状动脉造影（CAG）或经皮冠状动脉介入治疗（PCI）的患者的重要并发症。在这项回顾性观察性研究中，我们旨在确定 GDF-15 在急性心肌梗死（AMI）患者中的作用和 AKI 的风险。

方法

回顾性分析了 1195 例 AMI 患者的病历。排除标准后，共纳入 751 例符合条件的接受 CAG 或 PCI 的患者进行研究。记录术前临床参数，包括 GDF-15 水平。采用多变量 logistic 回归分析确定 AKI 的危险因素。随后，为了减少潜在的选择偏差并平衡两组之间的差异，进行了倾向评分匹配分析。记录总研究人群的 30 天全因死亡率。采用 Kaplan-Meier 分析确定 AMI 患者短期生存率与 GDF-15 水平之间的关系。

结果

在纳入的 751 例患者中，106 例（14.1%）发生 AKI。患者分为两组：AKI 组（n=106）和非 AKI 组（n=645）。与非 AKI 组相比，AKI 组的 GDF-15 水平显著升高（1328.2±349.7ng/L 比 1113.0±371.3ng/L，P<0.001）。多变量 logistic 回归分析显示，GDF-15 是 AKI 的独立危险因素（GDF-15 每增加 1000ng/L，OR：3.740，95%CI：1.940-7.207，P<0.001）。根据 GDF-15 三分位值，将患者分为三组。与最低 GDF-15 三分位组相比，中（OR 2.93，95%CI：1.46-5.89，P=0.003）和最高 GDF-15 三分位组（OR 3.72，95%CI：1.87-7.39，P<0.001）的患者 AKI 风险更高。匹配后的倾向评分匹配组包括 212 例患者。多变量 logistic 回归显示，匹配后 GDF-15 仍然是 AKI 的独立危险因素（GDF-15 每增加 1000ng/L，OR：2.395，95%CI：1.020-5.626，P=0.045）。基于 Kaplan-Meier 分析，较高 GDF-15 三分位组的 30 天全因死亡率风险增加（对数秩检验：29.895，P<0.001）。