血尿素氮与左心室射血分数比值与行经皮冠状动脉介入治疗的急性冠状动脉综合征患者对比剂肾病的关系。
Association of the blood urea nitrogen-to-left ventricular ejection fraction ratio with contrast-induced nephropathy in patients with acute coronary syndrome who underwent percutaneous coronary intervention.
机构信息
Department of Cardiology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Izmir, Turkey.
Cardiology Department, Balikesir University Faculty of Medicine, Balikesir, Turkey.
出版信息
Int Urol Nephrol. 2019 Mar;51(3):475-481. doi: 10.1007/s11255-018-2052-1. Epub 2019 Jan 2.
AIM
We investigated the predictive value of the blood urea nitrogen-to-left ventricular ejection fraction ratio (BUNEFr) to evaluate the risk of contrast-induced nephropathy (CIN) in acute coronary syndrome (ACS) patients who were treated with percutaneous coronary intervention (PCI).
METHODS
A total of 1010 ACS patients undergoing PCI were included in this study. The serum creatinine level was measured before and within 48-72 h of contrast medium administration. Contrast-induced nephropathy was defined as an absolute increase of 0.3 mg/dL or a relative increase of 25% from baseline serum creatinine within 48-72 h of contrast medium exposure. To evaluate the relation between BUNEFr and CIN, the patients were divided into a CIN group and a no-CIN group.
RESULTS
A total of 74 patients developed CIN (7.3%). Patients with CIN were older and had a higher BUNEFr than those without. Multivariate analysis showed that age, hypotension or positive inotrope support, history of stroke, contrast volume, and BUNEFr (OR 10.59, 95% CI 2.803-40.070, p = 0.001) were independent predictors of CIN. For the development of CIN, the AUC of a multivariable model that included hypotension or positive inotrope support, history of stroke, and contrast volume was 0.813 (95% CI 0.758-0.857, p < 0.001). When BUNEFr was added to a multivariable model, the AUC was 0.859 (95% CI 0.814-0.894, z = 3.204, difference p = 0.0014). Moreover, the addition of BUNEFr to a multivariable model was associated with a significant net reclassification improvement estimated at 49.4% (p < 0.001) and an integrated discrimination improvement of 0.044 (p = 0.0138).
CONCLUSION
The BUNEFr may be a useful new predictor of CIN in ACS patients treated with PCI. The inclusion of BUNEFr in a multivariable model could allow improved risk classification in these patients regarding the development of CIN.
目的
我们研究了血尿素氮与左心室射血分数比值（BUNEFr）对接受经皮冠状动脉介入治疗（PCI）的急性冠脉综合征（ACS）患者对比剂肾病（CIN）风险的预测价值。
方法
本研究纳入了 1010 例接受 PCI 的 ACS 患者。在给予对比剂前和 48-72 小时内测量血清肌酐水平。CIN 定义为对比剂暴露后 48-72 小时内血清肌酐绝对值增加 0.3mg/dL 或相对增加 25%。为了评估 BUNEFr 与 CIN 之间的关系，将患者分为 CIN 组和非 CIN 组。
结果
共有 74 例患者发生 CIN（7.3%）。与无 CIN 患者相比，CIN 患者年龄较大，BUNEFr 较高。多变量分析显示，年龄、低血压或正性肌力支持、卒中史、对比剂用量和 BUNEFr（OR 10.59，95%CI 2.803-40.070，p=0.001）是 CIN 的独立预测因素。对于 CIN 的发生，包含低血压或正性肌力支持、卒中史和对比剂用量的多变量模型的 AUC 为 0.813（95%CI 0.758-0.857，p<0.001）。当 BUNEFr 被添加到多变量模型中时，AUC 为 0.859（95%CI 0.814-0.894，z=3.204，差异 p=0.0014）。此外，将 BUNEFr 添加到多变量模型中与显著的净重新分类改善相关，估计值为 49.4%（p<0.001），综合判别改善为 0.044（p=0.0138）。
结论
BUNEFr 可能是接受 PCI 的 ACS 患者 CIN 的有用新预测指标。在多变量模型中包含 BUNEFr 可以改善这些患者 CIN 发生风险的分类。
Zotero 插件