Li Xihong, Chen Qingqing, Yang Xinrui, Li Duanbin, Du Changqing, Zhang Jun, Zhang Wenbin
Department of Clinical Laboratory, Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Cardiology, Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Cardiovasc Med. 2023 Aug 29;10:1128294. doi: 10.3389/fcvm.2023.1128294. eCollection 2023.
Contrast-associated acute kidney injury (CA-AKI) is a critical complication when applying contrast medium, and the risk factors of CA-AKI have not been fully clarified. This study aimed to explore the relationships of CA-AKI with erythrocyte parameters, anemia conditions, and sex differences in patients after coronary angiography (CAG).
In this retrospective study, 4,269 patients who underwent CAG were enrolled. CA-AKI was defined as an increase in plasma creatinine of at least 0.5 mg/dl (44 μmol/L) or 25% within 72 h after exposure to the contrast medium. Three erythrocyte parameters, including hemoglobin, hematocrit, and red blood cell (RBC) count, were collected on admission. Logistic regression analyses were used to examine the associations of sex differences and erythrocyte parameters with CA-AKI in the overall population, restricted cubic splines to visualize these associations flexibly. Moreover, stratified and sensitivity analyses were conducted to assess the robustness of the findings.
Overall, the mean (± standard deviations) age of patients was 67.05 ± 10.77 years, and 759 subjects (17.8%) developed CA-AKI. The results showed L-shaped relationships between erythrocyte parameters and CA-AKI incidence in each model (all < 0.001). The incidence of CA-AKI was positively associated with the severity of anemia, while it showed no significant differences among the types of anemia. Moreover, female patients undergoing CAG had a higher risk of CA-AKI than male patients. Mediation analysis verified that erythrocyte parameters exerted an indirect effect on the sex differences of CA-AKI incidences.
In conclusion, females, perioperative anemia conditions, and lower erythrocyte parameters (hemoglobin, hematocrit, and RBC count) were verified as risk factors of CA-AKI in patients undergoing CAG. Furthermore, lower erythrocyte parameters among females exerted indirect effects on the sex differences in CA-AKI incidence.
对比剂相关急性肾损伤（CA-AKI）是应用对比剂时的一种严重并发症，其危险因素尚未完全明确。本研究旨在探讨CA-AKI与冠状动脉造影（CAG）术后患者红细胞参数、贫血状况及性别差异之间的关系。
在这项回顾性研究中，纳入了4269例行CAG的患者。CA-AKI定义为在接触对比剂后72小时内血浆肌酐至少升高0.5 mg/dl（44 μmol/L）或升高25%。入院时收集三项红细胞参数，包括血红蛋白、血细胞比容和红细胞（RBC）计数。采用逻辑回归分析检验总体人群中性别差异和红细胞参数与CA-AKI的关联，使用受限立方样条灵活地可视化这些关联。此外，进行分层分析和敏感性分析以评估研究结果的稳健性。
总体而言，患者的平均（±标准差）年龄为67.05±10.77岁，759名受试者（17.8%）发生了CA-AKI。结果显示，在每个模型中红细胞参数与CA-AKI发生率之间呈L型关系（均<0.001）。CA-AKI的发生率与贫血严重程度呈正相关，而不同类型贫血之间无显著差异。此外，行CAG的女性患者发生CA-AKI的风险高于男性患者。中介分析证实红细胞参数对CA-AKI发生率的性别差异有间接影响。
总之，女性、围手术期贫血状况以及较低的红细胞参数（血红蛋白、血细胞比容和RBC计数）被证实为行CAG患者发生CA-AKI的危险因素。此外，女性较低的红细胞参数对CA-AKI发生率中的性别差异有间接影响。
