接受冠状动脉造影术的患者营养风险与造影剂相关急性肾损伤的相关性：一项横断面研究。

The association between nutritional risk and contrast-induced acute kidney injury in patients undergoing coronary angiography: a cross-sectional study.

机构信息

Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No 3 East of Qingchun Road, Hangzhou, 310000, Zhejiang Province, China.

Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Hangzhou, 310000, Zhejiang Province, China.

出版信息

Nutr J. 2022 Sep 16;21(1):56. doi: 10.1186/s12937-022-00810-z.

DOI:10.1186/s12937-022-00810-z

PMID:36114539

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9479352/

Abstract

BACKGROUND

Nutritional risk is prevalent in various diseases, but its association with contrast-induced acute kidney injury (CI-AKI) remains unclear. This study aimed to explore this association in patients undergoing coronary angiography (CAG).

METHODS

In this retrospective cross-sectional study, 4386 patients undergoing CAG were enrolled. Nutritional risks were estimated by nutritional risk screening 2002 (NRS-2002), controlling nutritional status (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI), respectively. CI-AKI was determined by the elevation of serum creatinine (Scr). Multivariable logistic regression analyses and receiver operator characteristic (ROC) analyses were conducted. Subgroup analyses were performed according to age (< 70/≥70 years), gender (male/female), percutaneous coronary intervention (with/without), and estimated glomerular filtration rate (< 60/≥60 ml/min/1.73m).

RESULTS

Overall, 787 (17.9%) patients were diagnosed with CI-AKI. The median score of NRS-2002, CONUT, PNI, and GNRI was 1.0, 3.0, 45.8, and 98.6, respectively. Nutritional risk was proven to be associated with CI-AKI when four different nutritional tools were employed, including NRS-2002 ([3-7 vs. 0]: odds ratio [95% confidence interval], OR [95%CI] = 4.026 [2.732 to 5.932], P < 0.001), CONUT ([6-12 vs. 0-1]: OR [95%CI] = 2.230 [1.586 to 3.136], P < 0.001), PNI ([< 38 vs. ≥52]: OR [95%CI] = 2.349 [1.529 to 3.610], P < 0.001), and GNRI ([< 90 vs. ≥104]: OR [95%CI] = 1.822 [1.229 to 2.702], P = 0.003). This is consistent when subgroup analyses were performed. Furthermore, nutritional scores were proved to be accurate in predicting CI-AKI (area under ROC curve: NRS-2002, 0.625; CONUT, 0.609; PNI, 0.629; and GNRI, 0.603).

CONCLUSIONS

Nutritional risks (high scores of NRS-2002 and CONUT; low scores of PNI and GNRI) were associated with CI-AKI in patients undergoing CAG.

摘要

背景

营养风险普遍存在于各种疾病中，但它与对比剂诱导的急性肾损伤（CI-AKI）之间的关系尚不清楚。本研究旨在探讨行冠状动脉造影（CAG）患者中的这种关联。

方法

这是一项回顾性的横断面研究，共纳入了 4386 例行 CAG 的患者。分别采用营养风险筛查 2002 量表（NRS-2002）、控制营养状况（CONUT）、预后营养指数（PNI）和老年营养风险指数（GNRI）评估营养风险。CI-AKI 由血清肌酐（Scr）升高来确定。采用多变量逻辑回归分析和受试者工作特征（ROC）曲线分析。根据年龄（<70/≥70 岁）、性别（男/女）、经皮冠状动脉介入治疗（有/无）和估算肾小球滤过率（<60/≥60ml/min/1.73m²）进行亚组分析。

结果

总体而言，787 例（17.9%）患者被诊断为 CI-AKI。NRS-2002、CONUT、PNI 和 GNRI 的中位数评分分别为 1.0、3.0、45.8 和 98.6。当使用四种不同的营养工具时，营养风险与 CI-AKI 相关，包括 NRS-2002（[3-7 分比 0 分]：比值比[95%置信区间]，OR[95%CI]为 4.026[2.732 至 5.932]，P<0.001）、CONUT（[6-12 分比 0-1 分]：OR[95%CI]为 2.230[1.586 至 3.136]，P<0.001）、PNI（[<38 分比≥52 分]：OR[95%CI]为 2.349[1.529 至 3.610]，P<0.001）和 GNRI（[<90 分比≥104 分]：OR[95%CI]为 1.822[1.229 至 2.702]，P=0.003）。在进行亚组分析时也得到了一致的结果。此外，营养评分在预测 CI-AKI 方面表现出了较好的准确性（ROC 曲线下面积：NRS-2002，0.625；CONUT，0.609；PNI，0.629；GNRI，0.603）。