Li Jing, Wang Zhen, Zhang BaiXiang, Zheng Di, Lu Yuan, Li Wenhua
Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China.
Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
Int Urol Nephrol. 2022 Sep;54(9):2385-2392. doi: 10.1007/s11255-022-03149-w. Epub 2022 Feb 19.
The present study aimed to investigate the value of preprocedural fibrinogen (FIB) combined with CHA2DS2-VASC scores in the risk prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with acute coronary syndromes (ACS).
A total of 934 patients (mean age 63.9 ± 11.5 years, and 32.1% female), who were admitted to our hospital for ACS and underwent PCI, were retrospectively enrolled. The patients were divided into two groups: non-CI-AKI group (n = 787) and CI-AKI group (n = 147). Contrast-induced acute kidney injury was defined as an increase of ≥ 0.5 mg/dL or ≥ 25% serum creatinine within 48-72 h after PCI. Spearman correlation analysis was used to determine the relationship between FIB and CHA2DS2-VASC scores.
Patients with high baseline FIB levels and high CHA2DS2-VASC scores had higher CI-AKI incidence. On spearman correlation analysis, FIB and CHA2DS2-VASC scores were positively correlated (R = 0.236, P < 0.001). The ROC statistical analysis showed that the combination had 63.3% sensitivity with 72.6% specificity for the development of CI-AKI (area under the curve: 0.727, 95% CI 0.697-0.755, P < 0.001). A total of 934 ACS patients were divided into low-risk group (404 cases), medium-risk group (383 cases) and high-risk group (147 cases) according to the cut-off values of FIB and CHA2DS2-VASC scores. The incidence of CI-AKI was higher in the high-risk group than in the low-risk and medium-risk groups (Log-rank χ2 = 104.505, 56.647. P < 0.001). Multivariate analysis revealed that albumin (OR = 0.913, 95% CI 0.867-0.962), FIB (OR = 1.451, 95% CI 1.185-1.77), CHA2DS2-VASC score (OR = 1.271, 95% CI 1.504-1.78) were the independent risk factors of CI-AKI (p < 0.05).
The preprocedural fibrinogen combined with CHA2DS2-VASC score is independently associated with the risk of CI-AKI in ACS patients treated by PCI.
本研究旨在探讨急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）前纤维蛋白原（FIB）联合CHA2DS2-VASC评分在预测对比剂诱导的急性肾损伤（CI-AKI）风险中的价值。
回顾性纳入我院收治的934例因ACS行PCI的患者（平均年龄63.9±11.5岁，女性占32.1%）。将患者分为两组：非CI-AKI组（n = 787）和CI-AKI组（n = 147）。对比剂诱导的急性肾损伤定义为PCI术后48 - 72小时内血清肌酐升高≥0.5mg/dL或≥25%。采用Spearman相关性分析确定FIB与CHA2DS2-VASC评分之间的关系。
基线FIB水平高和CHA2DS2-VASC评分高的患者CI-AKI发生率更高。Spearman相关性分析显示，FIB与CHA2DS2-VASC评分呈正相关（R = 0.236，P < 0.001）。ROC统计分析表明，该联合指标对CI-AKI发生的敏感性为63.3%，特异性为72.6%（曲线下面积：0.727，95%CI 0.697 - 0.755，P < 0.001）。根据FIB和CHA2DS2-VASC评分的截断值，将934例ACS患者分为低风险组（404例）、中风险组（383例）和高风险组（147例）。高风险组CI-AKI发生率高于低风险组和中风险组（Log-rank χ2 = 104.505，56.647。P < 0.001）。多因素分析显示，白蛋白（OR = 0.913，95%CI 0.867 - 0.962）、FIB（OR = 1.451，95%CI 1.185 - 1.77）、CHA2DS2-VASC评分（OR = 1.271，95%CI 1.504 - 1.78）是CI-AKI的独立危险因素（p < 0.05）。
PCI治疗的ACS患者，术前纤维蛋白原联合CHA2DS2-VASC评分与CI-AKI风险独立相关。
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