Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università 4, 41125 Modena, Italy.
Eur Heart J Acute Cardiovasc Care. 2021 May 25;10(4):445-452. doi: 10.1093/ehjacc/zuab003.
The aim of this study was to analyse the role of inflammation and established clinical scores in predicting acute kidney injury (AKI) after acute coronary syndromes (ACS).
In a prospective multicentre cohort including 2034 patients with ACS undergoing percutaneous coronary intervention, high-sensitivity C-reactive protein (hsCRP), neutrophil count, neutrophil-to-lymphocyte ratio (NL-ratio), and creatinine were measured at the index procedure. AKI (n = 39, defined according to RIFLE criteria) and major cardiovascular and cerebrovascular events were adjudicated after 1 year. Associations between inflammation, AKI, and cardiac death (CD) were assessed by C-statistics and Cox proportional hazard models with log-rank test to compare survival. Patients with ACS with elevated neutrophil count >7.8 × 109/L, NL-ratio >5, combined neutrophil-count/creatinine, or NL-ratio/creatinine at baseline showed a higher incidence of AKI (all P < 0.05) and CD (all P < 0.001). The risk of AKI, CD, and their combination was increased in patients with higher neutrophil count/creatinine (heart rate (HR) = 3.7, 95% cardiac index (CI) 1.9-7.1; HR = 2.7, 95% CI 1.6-4.6; HR = 3.2, 95% CI 2.1-4.9); NL-ratio/creatinine (HR = 2.1, 95% CI 1.6-4.1; HR = 2.2, 95% CI 1.3-3.8; HR = 2.3, 95% CI 1.5-3.5); and hsCRP (HR = 1.8, 95% CI 0.9-3.5; HR = 2.2, 95% CI 1.3-3.6; HR = 1.9, 95% CI 1.2-2.8) after adjustment for age, diabetes, hypertension, previous heart failure, kidney function, haemodynamic instability at admission, statin, and renin-angiotensin-aldosterone antagonists use. Subjects with higher GRACE score 1.0/NL-ratio had higher rate of AKI, CD, and both (HR = 1.4, 95% CI 0.5-4.2; HR = 2.7, 95% CI 1.3-5.9; HR = 2.1, 95% CI 1-4.3).
Inflammation markers may predict AKI after correction for renal function at the index procedure. hsCRP performed better than the NL-ratio. However, the integration of inflammation markers to traditional risk factors or scores does not add prognostic information.
ClinicalTrials.gov, NCT01000701.
本研究旨在分析炎症和既定临床评分在预测急性冠状动脉综合征（ACS）后急性肾损伤（AKI）中的作用。
在一项前瞻性多中心队列研究中，纳入了 2034 名接受经皮冠状动脉介入治疗的 ACS 患者，在指数程序中测量了高敏 C 反应蛋白（hsCRP）、中性粒细胞计数、中性粒细胞与淋巴细胞比值（NL-ratio）和肌酐。在 1 年后对 AKI（根据 RIFLE 标准定义）和主要心血管和脑血管事件进行了裁决。通过 C 统计量和 Cox 比例风险模型评估炎症、AKI 和心脏死亡（CD）之间的相关性，并通过对数秩检验比较生存。基线时中性粒细胞计数>7.8×109/L、NL-ratio>5、联合中性粒细胞计数/肌酐或 NL-ratio/肌酐的 ACS 患者，AKI（均 P<0.05）和 CD（均 P<0.001）发生率更高。在基线时具有更高的中性粒细胞计数/肌酐（心率（HR）=3.7，95%置信区间（CI）1.9-7.1；HR=2.7，95%CI 1.6-4.6；HR=3.2，95%CI 2.1-4.9）、NL-ratio/creatinine（HR=2.1，95%CI 1.6-4.1；HR=2.2，95%CI 1.3-3.8；HR=2.3，95%CI 1.5-3.5）和 hsCRP（HR=1.8，95%CI 0.9-3.5；HR=2.2，95%CI 1.3-3.6；HR=1.9，95%CI 1.2-2.8）的患者中，AKI、CD 和两者的风险增加，调整了年龄、糖尿病、高血压、既往心力衰竭、肾功能、入院时血流动力学不稳定、他汀类药物和肾素-血管紧张素-醛固酮拮抗剂的使用后。GRACE 评分 1.0/NL-ratio 较高的患者 AKI、CD 和两者的发生率均较高（HR=1.4，95%CI 0.5-4.2；HR=2.7，95%CI 1.3-5.9；HR=2.1，95%CI 1-4.3）。
在指数程序中对肾功能进行校正后，炎症标志物可能预测 AKI。hsCRP 比 NL-ratio 表现更好。然而，将炎症标志物整合到传统危险因素或评分中并不能增加预后信息。
ClinicalTrials.gov，NCT01000701。
