天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值对择期经皮冠状动脉介入治疗患者造影剂相关急性肾损伤的预测价值。
Predictive value of aspartate aminotransferase-to-alanine aminotransferase ratio for contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention.
机构信息
Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China; Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Cardiovascular Institute, Fujian Provincial Center for Geriatrics, Fujian Clinical Medical Research Center for Cardiovascular Diseases, Fuzhou, China; Fujian Heart Failure Center Alliance, Fuzhou, China.
Department of Geriatric Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fuzhou, China.
出版信息
J Cardiol. 2022 May;79(5):618-625. doi: 10.1016/j.jjcc.2021.11.009. Epub 2021 Nov 29.
BACKGROUND
Pre-procedure liver insufficiency has been demonstrated as a poor prognostic factor after percutaneous coronary intervention (PCI). Recent research discovered that the aspartate aminotransferase-to-alanine aminotransferase ratio (De-Ritis ratio) reflects the severity of liver insufficiency and was associated with adverse outcomes. We aim to evaluate the predictive value of the De-Ritis ratio for contrast-associated acute kidney injury (CA-AKI) and long-term mortality in patients undergoing elective PCI.
METHODS
We retrospectively enrolled 5780 consenting patients undergoing elective PCI between January 2012 and December 2018. CA-AKI was defined as an increase in serum creatinine ≥0.3 mg/dl or ≥50% within 48 h after the administration of contrast media.
RESULTS
The incidence of CA-AKI was 6.3% (n = 363). The De-Ritis ratio >1.30 was identified as the best cut-off value for CA-AKI prediction. The De-Ritis ratio showed an area under the curve (AUC) of 0.636 [95% confidence interval (CI): 0.605-0.667] in predicting CA-AKI, which was significantly greater than alanine aminotransferase (p<0.001) and aspartate aminotransferase (p = 0.012) alone. Furthermore, compared to currently recognized liver function assessment tools, the predictive value of the De-Ritis ratio on CA-AKI was similar to the MELD score (AUC: 0.636 vs 0.626, p = 0.631) and higher than the MELD-XI score (AUC: 0.636 vs 0.561, p<0.001). Multivariate logistic analysis showed that the De-Ritis ratio >1.30 was independently associated with CA-AKI (odds ratio=1.551, 95% CI: 1.185-2.030, p = 0.001). The addition of the De-Ritis ratio to the fully adjusted logistic regression model has significant incremental effects on the risk prediction for CA-AKI with a continuous net reclassification improvement of 0.395 (p<0.001) and an integrated discrimination improvement of 0.005 (p = 0.018). Additionally, the De-Ritis ratio >1.30 was significantly associated with long-term mortality (hazard ratio=1.285, 95% CI: 1.007-1.641, p = 0.044).
CONCLUSIONS
The De-Ritis ratio was an independent risk factor for CA-AKI and long-term mortality in patients undergoing elective PCI.
背景
经皮冠状动脉介入治疗（PCI）后，术前肝功能不全已被证明是预后不良的一个因素。最近的研究发现，天门冬氨酸氨基转移酶/丙氨酸氨基转移酶比值（De-Ritis 比值）反映了肝功能不全的严重程度，并与不良结局相关。我们旨在评估 De-Ritis 比值对行择期 PCI 患者造影剂相关急性肾损伤（CA-AKI）和长期死亡率的预测价值。
方法
我们回顾性纳入了 2012 年 1 月至 2018 年 12 月间行择期 PCI 的 5780 名患者。CA-AKI 定义为使用造影剂后 48 小时内血清肌酐升高≥0.3mg/dl 或≥50%。
结果
CA-AKI 的发生率为 6.3%（n=363）。De-Ritis 比值>1.30 被确定为预测 CA-AKI 的最佳截断值。De-Ritis 比值预测 CA-AKI 的曲线下面积（AUC）为 0.636（95%CI：0.605-0.667），显著大于丙氨酸氨基转移酶（p<0.001）和天门冬氨酸氨基转移酶（p=0.012）单独预测的 AUC。此外，与目前公认的肝功能评估工具相比，De-Ritis 比值对 CA-AKI 的预测价值与 MELD 评分相似（AUC：0.636 与 0.626，p=0.631），高于 MELD-XI 评分（AUC：0.636 与 0.561，p<0.001）。多变量 logistic 分析显示，De-Ritis 比值>1.30 与 CA-AKI 独立相关（比值比=1.551，95%CI：1.185-2.030，p=0.001）。De-Ritis 比值加入完全调整的 logistic 回归模型后，对 CA-AKI 的风险预测具有显著的增量效应，连续净重新分类改善 0.395（p<0.001），综合判别改善 0.005（p=0.018）。此外，De-Ritis 比值>1.30 与长期死亡率显著相关（风险比=1.285，95%CI：1.007-1.641，p=0.044）。
结论
De-Ritis 比值是行择期 PCI 患者发生 CA-AKI 和长期死亡率的独立危险因素。
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