Department of Emergency Medicine, Disaster Medical Center, West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
Cardiovasc Diabetol. 2023 Apr 20;22(1):92. doi: 10.1186/s12933-023-01831-6.
Acute kidney injury (AKI) can be caused by multiple factors/events, including acute coronary syndrome (ACS). Ceramides are involved in atherosclerosis progression, cardiovascular events, and renal damage. Almost no studies have been conducted on the relationship between ceramide concentrations and AKI events. Therefore, we evaluated the association between plasma ceramide level at admission and AKI in patients with ACS undergoing percutaneous coronary intervention.
We enrolled 842 ACS patients from the Prospective Multicenter Study for Early Evaluation of Acute Chest Pain. AKI was defined using the criteria from the 2012 Kidney Disease: Improving Global Outcomes. Eleven C16-C26 ceramides were measured using the high-performance liquid chromatography interfaced to tandem mass spectrometer procedure. Logistic regression models were used to evaluate relationships between ceramides and AKI risk. The area under the receiver operating characteristic curves (AUC) was used to evaluate differences between ceramides.
Overall, 139 (16.5%) patients developed AKI during hospitalisation. Patients who developed AKI had higher levels of Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/21:0), Cer(d18:1/24:1), and Cer(d18:1/24:2) than patients who did not (P < 0.05). In risk-factor adjusted logistic regression models, these ceramides were independently associated with AKI risk (P < 0.05). Cer(d18:1/24:2) had the highest odds ratio of 3.503 (Q4 vs. Q1, 95% confidence interval: 1.743-7.040, P < 0.001). Ceramides had AUCs of 0.581-0.661 (P < 0.001) for AKI. Each ceramide combined with the Mehran risk score (AUC: 0.780) had AUCs of 0.802-0.808, greater than the Mehran risk score alone.
Long-chain and very-long-chain ceramide levels may help determine the high AKI risk beyond traditional assessments.
急性肾损伤（AKI）可由多种因素/事件引起，包括急性冠状动脉综合征（ACS）。神经酰胺参与动脉粥样硬化进展、心血管事件和肾脏损伤。几乎没有研究探讨神经酰胺浓度与 AKI 事件之间的关系。因此，我们评估了 ACS 患者经皮冠状动脉介入治疗入院时血浆神经酰胺水平与 AKI 之间的关系。
我们从前瞻性多中心急性胸痛早期评估研究中纳入了 842 例 ACS 患者。AKI 采用 2012 年肾脏病：改善全球预后组织的标准定义。采用高效液相色谱-串联质谱法测定 11 种 C16-C26 神经酰胺。采用逻辑回归模型评估神经酰胺与 AKI 风险之间的关系。采用受试者工作特征曲线下面积（AUC）评估神经酰胺之间的差异。
共有 139 例（16.5%）患者在住院期间发生 AKI。发生 AKI 的患者Cer(d18:1/16:0)、Cer(d18:1/18:0)、Cer(d18:1/20:0)、Cer(d18:1/21:0)、Cer(d18:1/24:1)和 Cer(d18:1/24:2)水平高于未发生 AKI 的患者（P<0.05）。在调整风险因素的逻辑回归模型中，这些神经酰胺与 AKI 风险独立相关（P<0.05）。Cer(d18:1/24:2)的比值比最高，为 3.503（四分位数范围[Q4]比 Q1，95%置信区间：1.743-7.040，P<0.001）。神经酰胺对 AKI 的 AUC 为 0.581-0.661（P<0.001）。与 Mehran 风险评分（AUC：0.780）联合使用的每种神经酰胺的 AUC 为 0.802-0.808，均大于单独使用 Mehran 风险评分。
长链和超长链神经酰胺水平可能有助于确定传统评估之外的高 AKI 风险。
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