Sun Yanhu, Zheng Di, Zhang Quan, Li Wenhua
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China.
Biomed Rep. 2020 Oct;13(4):26. doi: 10.3892/br.2020.1333. Epub 2020 Jul 22.
Contrast-induced nephropathy (CIN) is a common adverse event in the diagnosis and treatment of coronary intervention. The current study investigated the predictive effect of preoperative fibrinogen (FIB) combined with antithrombin III (AT-III) on CIN following percutaneous coronary intervention (PCI). A total of 394 patients who underwent PCI between October 2018 and May 2019 were selected for the present study. Pre-procedural FIB levels and AT-III activity were measured before PCI. CIN was defined as a 0.5 mg/dl or 25% increase in serum creatinine levels 48 to 72 h after exposure to a radiocontrast agent. Patients were classified into CIN and non-CIN groups. CIN occurred in 48 (12.2%) patients. The serum FIB levels were significantly higher in patients who developed CIN compared with those who did not develop CIN. In addition, AT-III levels ≤89.5% were associated with higher rates of CIN. Logistical regression analysis showed that high FIB, and low AT-III and albumin levels were high-risk factors associated with CIN. For FIB, the area under the receiver operating characteristic curve (AUC) for predicting CIN was 0.653. The optimal cut-off value was 3.48 g/l with a sensitivity of 45.8% and a specificity of 79.7% [95% confidence interval (CI): 0.603-0.701; P=0.0002)]. For AT-III, the AUC was 0.711, and the optimal cut-off value was 89.5%, with a sensitivity of 81.3% and specificity of 58.2% (95% CI: 0.659-0.758; P<0.0001). When combining FIB and AT-III, the AUC was 0.747. The optimal cut-off value was 0.090424, with a diagnostic sensitivity of 93.8% and specificity of 46.6% (95% CI: 0.697-0.792; P<0.0001). The results showed that FIB combined with AT-III resulted in improved predictive accuracy of CIN (FIB vs. AT-III, AUC=0.653 vs. 0.711, P=0.292; FIB vs. FIB + AT-III, AUC=0.653 vs. 0.747, P=0.012; AT-III vs. FIB + AT-III, AUC=0.711 vs. 0.747, P=0.138). Pre-procedural levels of FIB, AT-III and albumin were independently associated with an increased risk of CIN. Furthermore, the results suggested that the combination of FIB and AT-III was a better predictor of CIN after PCI.
对比剂肾病（CIN）是冠状动脉介入诊断和治疗中常见的不良事件。本研究探讨术前纤维蛋白原（FIB）联合抗凝血酶III（AT-III）对经皮冠状动脉介入治疗（PCI）后CIN的预测作用。选取2018年10月至2019年5月期间行PCI的394例患者进行本研究。在PCI术前测量术前FIB水平和AT-III活性。CIN定义为在接触放射性对比剂后48至72小时血清肌酐水平升高0.5mg/dl或升高25%。患者分为CIN组和非CIN组。48例（12.2%）患者发生CIN。发生CIN的患者血清FIB水平显著高于未发生CIN的患者。此外，AT-III水平≤89.5%与较高的CIN发生率相关。逻辑回归分析显示，高FIB、低AT-III和白蛋白水平是与CIN相关的高危因素。对于FIB，预测CIN的受试者工作特征曲线（AUC）下面积为0.653。最佳截断值为3.48g/l，敏感性为45.8%，特异性为79.7%[95%置信区间（CI）：0.603-0.701；P=0.0002]。对于AT-III，AUC为0.711，最佳截断值为89.5%，敏感性为81.3%，特异性为58.2%（95%CI：0.659-0.758；P<0.0001）。当联合FIB和AT-III时，AUC为0.747。最佳截断值为0.090424，诊断敏感性为93.8%，特异性为46.6%（95%CI：0.697-0.792；P<0.0001）。结果显示，FIB联合AT-III提高了CIN的预测准确性（FIB与AT-III比较，AUC=0.653对0.711，P=0.292；FIB与FIB+AT-III比较，AUC=0.653对0.747，P=0.012；AT-III与FIB+AT-III比较，AUC=0.711对0.747，P=0.138）。术前FIB、AT-III和白蛋白水平与CIN风险增加独立相关。此外，结果表明FIB和AT-III联合是PCI后CIN的更好预测指标。
