Guangdong General Hospital Zhuhai Hospital, Zhuhai Golden Bay Center Hospital, Zhuhai, 519040, China.
Department of Cardiology, Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.
Heart Lung Circ. 2019 Jun;28(6):866-873. doi: 10.1016/j.hlc.2018.04.291. Epub 2018 May 16.
The clinical implications of different definitions of contrast-induced nephropathy (CIN) in patients without baseline renal dysfunction are not well defined.
Consecutive patients at a single centre without baseline renal dysfunction (estimated glomerular filtration rate, eGFR≥60ml/min/1.73m) undergoing coronary angiography or percutaneous coronary intervention (PCI), were systematically evaluated for long-term risk of mortality following CIN using two broad definitions: an absolute increase from baseline in serum creatinine (SCr) ≥0.3mg/dl (mild to severe absolute CIN) and a relative increase from baseline of 25% (mild to severe relative CIN) within 72hours.
Of 2,823 subjects alive before discharge following coronary angiography there were 320 episodes of mild to severe relative CIN (11.3%) and 125 of mild to severe absolute CIN (4.4%). During a median follow-up of 2.3years, 73 patients (3.2%) died. After adjustment for confounders, mild to severe absolute CIN was associated with an adjusted hazard ratio (HR) (95% confidence interval) for all-cause mortality of 3.31 (1.74-6.30) (p<0.0001) and relative CIN with an adjusted HR of 1.92 (1.09, 3.38) (p=0.024). The risk of mortality rose with severity of CIN. Two commonly used definitions of CIN combining absolute and relative terms (increase ≥ 0.3mg/dl or 50%, and ≥ 0.5mg/dl or 25% from the baseline) confirmed these results.
Among patients without baseline renal dysfunction undergoing coronary angiography, the incidence of CIN can range widely depending on definition. Absolute CIN is less common than relative CIN. Regardless of definition, CIN is associated with a markedly increased risk of long-term mortality. This finding requires confirmation in multicentre studies.
在没有基线肾功能障碍的患者中，不同对比剂诱导肾病（CIN）定义的临床意义尚不清楚。
在一家单中心，对没有基线肾功能障碍（估计肾小球滤过率[eGFR]≥60ml/min/1.73m）的连续患者进行系统评估，使用两种广泛的定义来评估 CIN 后长期死亡率的风险：血清肌酐（SCr）从基线升高绝对值≥0.3mg/dl（轻度至重度绝对 CIN）和 72 小时内从基线升高 25%（轻度至重度相对 CIN）。
在接受冠状动脉造影术并存活出院的 2823 例患者中，有 320 例出现轻度至重度相对 CIN（11.3%）和 125 例出现轻度至重度绝对 CIN（4.4%）。在中位随访 2.3 年后，73 名患者（3.2%）死亡。在调整混杂因素后，轻度至重度绝对 CIN 与全因死亡率的调整后危险比（HR）（95%置信区间）相关为 3.31（1.74-6.30）（p<0.0001），相对 CIN 为 1.92（1.09-3.38）（p=0.024）。CIN 的严重程度与死亡率的升高相关。两种常用的 CIN 定义（绝对值增加≥0.3mg/dl 或 50%，以及从基线增加≥0.5mg/dl 或 25%）都证实了这些结果。
在没有基线肾功能障碍的接受冠状动脉造影术的患者中，CIN 的发生率根据定义而有很大差异。绝对 CIN 比相对 CIN 少见。无论定义如何，CIN 与长期死亡率显著增加相关。这一发现需要在多中心研究中得到证实。
