Lin Kai-Yang, Chen Han-Chuan, Jiang Hui, Wang Sun-Ying, Chen Hong-Mei, Wu Zhi-Yong, Jiang Feng, Guo Yan-Song, Zhu Peng-Li
Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, 350001, China.
Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fuzhou, 350001, China.
BMC Nephrol. 2020 Mar 10;21(1):90. doi: 10.1186/s12882-020-01743-7.
DD was found to be associated with acute myocardial infarction (AMI) and renal insufficiency. However, it is uncertain whether DD is an independent risk factor of CI-AKI in patients undergoing pPCI.
We prospectively enrolled 550 consecutive patients with STEMI undergoing pPCI between January 2012 and December 2016. The predictive value of admission DD for CI-AKI was assessed by receiver operating characteristic (ROC) and multivariable logistic regression analysis. CI-AKI was defined as an absolute serum creatinine increase ≥0.3 mg/dl or a relative increase in serum creatinine ≥50% within 48 h of contrast medium exposure.
Overall, the incidence of CI-AKI was 13.1%. The ROC analysis showed that the cutoff point of DD was 0.69 μg/ml for predicting CI-AKI with a sensitivity of 77.8% and a specificity of 57.3%. The predictive value of DD was similar to the Mehran score for CI-AKI (AUC = 0.729 vs AUC = 0.722; p = 0.8298). Multivariate logistic regression analysis indicated that DD > 0.69 μg/ml was an independent predictor of CI-AKI (odds ratio [OR] = 3.37,95% CI:1.80-6.33, p < 0.0001). Furthermore, DD > 0.69 μg/ml was associated with an increased risk of long-term mortality during a mean follow-up period of 16 months (hazard ratio = 3.41, 95%CI:1.4-8.03, p = 0.005).
Admission DD > 0.69 μg/ml was a significant and independent predictor of CI-AKI and long-term mortality in patients undergoing pPCI.
D - 二聚体（DD）被发现与急性心肌梗死（AMI）和肾功能不全相关。然而，在接受急诊经皮冠状动脉介入治疗（pPCI）的患者中，DD是否为造影剂诱导的急性肾损伤（CI - AKI）的独立危险因素尚不确定。
我们前瞻性纳入了2012年1月至2016年12月期间连续550例接受pPCI的ST段抬高型心肌梗死（STEMI）患者。通过受试者工作特征（ROC）曲线和多变量逻辑回归分析评估入院时DD对CI - AKI的预测价值。CI - AKI定义为在造影剂暴露后48小时内血清肌酐绝对升高≥0.3mg/dl或血清肌酐相对升高≥50%。
总体而言，CI - AKI的发生率为13.1%。ROC分析显示，DD预测CI - AKI的截断点为0.69μg/ml，敏感性为77.8%，特异性为57.3%。DD对CI - AKI的预测价值与Mehran评分相似（AUC = 0.729 vs AUC = 0.722；p = 0.8298）。多变量逻辑回归分析表明，DD > 0.69μg/ml是CI - AKI的独立预测因素（比值比[OR] = 3.37，95%可信区间：1.80 - 6.33，p < 0.0001）。此外，在平均16个月的随访期内，DD > 0.69μg/ml与长期死亡风险增加相关（风险比 = 3.41，95%可信区间：1.4 - 8.03，p = 0.005）。
入院时DD > 0.69μg/ml是接受pPCI患者发生CI - AKI和长期死亡的重要独立预测因素。
