Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman St, Tel Aviv, 64239, Israel.
J Nephrol. 2019 Jun;32(3):437-443. doi: 10.1007/s40620-019-00594-2. Epub 2019 Jan 31.
Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), however, the optimal time frame to measure CRP for risk stratification is not known. We evaluated the relation between the change in CRP over time (CRP velocity-CRPv) and AKI among STEMI patients treated with primary PCI.
We included 801 STEMI who presented between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in h) between the two measurements. Patient's medical records were reviewed for occurrence of AKI.
Mean age was 62 ± 16 and 80% were males. Patients with AKI had significantly higher CRPv (1.47 versus 0.4 mg/l/h, p < 0.001). In a multivariate regression model CRPv was independently associated with AKI (OR 1.03, 95% CI 1.01-1.0 5, p = 0.001). On receiver operating characteristic (ROC) curve the optimal cutoff value of CRPv to predict AKI was measured as more than 0.8 mg/l/h, with 70% sensitivity and 65% specificity (AUC 0.712, 95% CI 0.64-0.78, p < 0.001).
CRPv might be an independent and rapidly measurable biomarker for AKI following primary PCI in STEMI patients.
在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，升高的 C 反应蛋白（CRP）与急性肾损伤（AKI）风险增加相关，然而，用于风险分层的 CRP 最佳测量时间框架尚不清楚。我们评估了 STEMI 患者接受直接 PCI 治疗后 CRP 随时间变化（CRP 速度-CRPv）与 AKI 之间的关系。
我们纳入了 2007 年至 2017 年间就诊的 801 例 STEMI 患者，在入院后 24 小时内至少两次使用宽范围测定法（wr-CRP）测量 CRP。CRPv 定义为两次测量之间 wr-CRP 浓度（mg/L）的变化除以时间（h）的变化。回顾患者病历以确定 AKI 的发生情况。
平均年龄为 62±16 岁，80%为男性。发生 AKI 的患者 CRPv 显著更高（1.47 与 0.4mg/L/h，p<0.001）。在多变量回归模型中，CRPv 与 AKI 独立相关（OR 1.03，95%CI 1.01-1.05，p=0.001）。在受试者工作特征（ROC）曲线中，CRPv 预测 AKI 的最佳截断值定义为大于 0.8mg/L/h，具有 70%的敏感性和 65%的特异性（AUC 0.712，95%CI 0.64-0.78，p<0.001）。
在 STEMI 患者直接 PCI 后，CRPv 可能是 AKI 的一个独立且可快速测量的生物标志物。
