Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People's Republic of China.
Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People's Republic of China.
Clin Interv Aging. 2024 Mar 8;19:411-420. doi: 10.2147/CIA.S447042. eCollection 2024.
The estimated glomerular filtration rate (eGFR) based on creatinine is crucial for the risk assessment of contrast-associated acute kidney injury (CA-AKI). In recent, the difference between cystatin C-based eGFR (eGFRcys) and creatinine-based eGFR (eGFRcr) has been widely documented. We aimed to explore whether intraindividual differences between eGFRcys and eGFRcr had potential value for CA-AKI risk assessment in patients undergoing elective percutaneous coronary intervention (PCI).
From January 2012 to December 2018, we retrospectively observed 5049 patients receiving elective PCI. To determine eGFR, serum creatinine and cystatin C levels were measured. CA-AKI was defined as serum creatinine being increased ≥ 50% or 0.3 mg/dL within 48 h after contrast agents exposure. Chronic kidney disease (CKD) was defined as the eGFR < 60 mL/min/1.73 m.
Approximately half of the participants (2479, 49.1%) had a baseline eGFRdiff (eGFRcys-eGFRcr) between -15 and 15 mL/min/1.73 m. Restricted cubic splines analysis revealed a nonlinear relationship between eGFRdiff and CA-AKI. Multivariable logistic regression analysis indicated that compared with the reference group (-15 to 15 mL/min/1.73 m), the negative-eGFRdiff group (less than -15 mL/min/1.73 m) had a higher risk of CA-AKI (OR, 3.44; 95% CI, 2.57-4.64). Furthermore, patients were divided into four groups based on CKD identified by eGFRcys or eGFRcr. Multivariable logistic analysis revealed that patients with either CKDcys (OR, 2.94; 95% CI, 2.19-3.95, < 0.001) or CKDcr (OR, 2.44; 95% CI, 1.19-4.63, < 0.001) had an elevated risk of CA-AKI compared to those without CKDcys and CKDcr.
There are frequent intraindividual differences between eGFRcys and eGFRcr, and these differences can be used to forecast the risk of CA-AKI.
基于肌酐的估算肾小球滤过率（eGFR）对造影剂相关急性肾损伤（CA-AKI）的风险评估至关重要。最近，胱抑素 C 基 eGFR（eGFRcys）与肌酐基 eGFR（eGFRcr）之间的差异已被广泛记录。我们旨在探讨在接受择期经皮冠状动脉介入治疗（PCI）的患者中，eGFRcys 与 eGFRcr 之间的个体内差异是否对 CA-AKI 风险评估具有潜在价值。
我们回顾性观察了 2012 年 1 月至 2018 年 12 月期间接受择期 PCI 的 5049 例患者。为了确定 eGFR，测量了血清肌酐和胱抑素 C 水平。CA-AKI 定义为造影剂暴露后 48 小时内血清肌酐升高≥50%或 0.3mg/dL。慢性肾脏病（CKD）定义为 eGFR＜60ml/min/1.73m。
大约一半的参与者（2479 人，49.1%）的基线 eGFRdiff（eGFRcys-eGFRcr）在-15 至 15ml/min/1.73m 之间。限制性立方样条分析显示 eGFRdiff 与 CA-AKI 之间存在非线性关系。多变量逻辑回归分析表明，与参考组（-15 至 15ml/min/1.73m）相比，负 eGFRdiff 组（小于-15ml/min/1.73m）发生 CA-AKI 的风险更高（OR，3.44；95%CI，2.57-4.64）。此外，根据 eGFRcys 或 eGFRcr 确定的 CKD，将患者分为四组。多变量逻辑分析显示，与无 CKDcys 和 CKDcr 的患者相比，CKDcys（OR，2.94；95%CI，2.19-3.95，＜0.001）或 CKDcr（OR，2.44；95%CI，1.19-4.63，＜0.001）患者发生 CA-AKI 的风险更高。
eGFRcys 与 eGFRcr 之间存在频繁的个体内差异，这些差异可用于预测 CA-AKI 的风险。
