Shen Guoqi, He Haiyan, Zhang Xudong, Wang Linsheng, Wang Zhen, Li Fangfang, Lu Yuan, Li Wenhua
Institute of Cardiovascular Diseases, Xuzhou Medical University, Xuzhou, 221000, China.
Department of Cardiology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou, 221000, China.
Int Urol Nephrol. 2024 Mar;56(3):1147-1156. doi: 10.1007/s11255-023-03762-3. Epub 2023 Sep 2.
To investigate the relationship between the incidence of contrast-induced acute kidney injury (CI-AKI) after emergency percutaneous coronary intervention (PCI) and preoperative systemic immune-inflammation index (SII) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with acute ST-segment elevation myocardial infarction (STEMI), and to further analyze the predictive value of the combination of SII and NT-proBNP for CI-AKI.
The clinical data of 1543 patients with STEMI who underwent emergency PCI in our hospital from February 2019 to December 2022 were retrospectively analyzed. All patients were divided into training cohort (n = 1085) and validation cohort (n = 287) according to chronological order. The training cohort was divided into CI-AKI (n = 95) and non-CI-AKI (n = 990) groups according to the 2018 European Society of Urogenital Radiology definition of CI-AKI. Multivariate Logistic regression analysis was used to determine the independent risk factors for CI-AKI. Restricted cubic spline (RCS) was used to explore the relationship between SII, NT-proBNP, and the risk of CI-AKI. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SII, NT-proBNP, and their combination in CI-AKI.
The incidence of CI-AKI was 8.8% (95/1085). Multivariate logistic regression analysis showed that SII, NT-proBNP, age, baseline creatinine, fasting blood glucose, and diuretics were independent risk factors for CI-AKI. RCS analysis showed that SII > 1084.97 × 10/L and NT-proBNP > 296.12 pg/mL were positively associated with the incidence of CI-AKI. ROC curve analysis showed that the area under the curve of SII and NT-proBNP combined detection in predicting CI-AKI was 0.726 (95% CI 0.698-0.752, P < 0.001), the sensitivity was 60.0%, and the specificity was 77.7%, which were superior to the detection of SII or NT-proBNP alone.
Preprocedural high SII and NT-proBNP are independent risk factors for CI-AKI after emergency PCI in patients with STEMI. The combined detection of SII and NT-proBNP can more accurately predict CI-AKI risk than the single detection.
探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）后对比剂诱导的急性肾损伤（CI-AKI）的发生率与术前全身免疫炎症指数（SII）及N末端脑钠肽前体（NT-proBNP）水平之间的关系，并进一步分析SII与NT-proBNP联合检测对CI-AKI的预测价值。
回顾性分析2019年2月至2022年12月在我院接受急诊PCI的1543例STEMI患者的临床资料。所有患者按时间顺序分为训练队列（n = 1085）和验证队列（n = 287）。根据2018年欧洲泌尿生殖放射学会对CI-AKI的定义，将训练队列分为CI-AKI组（n = 95）和非CI-AKI组（n = 990）。采用多因素Logistic回归分析确定CI-AKI的独立危险因素。使用受限立方样条（RCS）探索SII、NT-proBNP与CI-AKI风险之间的关系。采用受试者工作特征（ROC）曲线评估SII、NT-proBNP及其联合检测对CI-AKI的预测价值。
CI-AKI的发生率为8.8%（95/1085）。多因素Logistic回归分析显示，SII、NT-proBNP、年龄、基线肌酐、空腹血糖和利尿剂是CI-AKI的独立危险因素。RCS分析显示，SII>1084.97×10⁹/L和NT-proBNP>296.12 pg/mL与CI-AKI的发生率呈正相关。ROC曲线分析显示，SII与NT-proBNP联合检测预测CI-AKI的曲线下面积为0.726（95%CI 0.698-0.752，P<0.001），灵敏度为60.0%，特异度为77.7%，优于单独检测SII或NT-proBNP。
术前高SII和NT-proBNP是STEMI患者急诊PCI后发生CI-AKI的独立危险因素。SII与NT-proBNP联合检测比单独检测能更准确地预测CI-AKI风险。
