Luo Ziyun, Li Yong, Xie Minjuan, Yi Song, Xu Shizhang, Luo Jun
Department of Nephrology, Yichun People's Hospital, Yichun, 336000, Jiangxi, China.
Department of Cardiology, The First People's Hospital of Yuhang District, Hangzhou, 311100, Zhejiang, China.
Int Urol Nephrol. 2025 Feb;57(2):595-602. doi: 10.1007/s11255-024-04204-4. Epub 2024 Sep 12.
Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Soluble suppression of tumorigenicity 2 (sST2) is associated with AKI. However, the relationship between sST2 and CI-AKI is unclear. This study aimed to investigate the relationship between sST2 and CI-AKI in patients with STEMI.
This was a single-center retrospective observational study. Patients diagnosed with STEMI in the Yichun People's Hospital from February 2020 to May 2024 were continuously included. CI-AKI was defined as an increase in serum creatinine of at least 50% or 0.3 mg/dL from baseline within 48-72 h after contrast exposure.
The incidence of CI-AKI after PCI was 12.4% (98/791). Univariate analysis showed that age, fasting plasma glucose, diabetes mellitus, Killip class, left ventricular ejection fraction, estimated glomerular filtration rate, high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and sST2 were associated with CI-AKI. The above factors were included in a multivariate analysis, which showed that sST2 was an independent factor for CI-AKI after PCI. The restricted cubic splines showed a nonlinear dose-response relationship between sST2 and CI-AKI (P < 0.001). The integration of the sST2 could significantly improve the ability of the model to identify CI-AKI (NRI 0.681, 95% CI 0.474-0.887; IDI 0.063, 95% CI 0.038-0.099).
Elevated sST2 is an independent risk factor for CI-AKI after PCI in patients with STEMI. Integration of sST2 can significantly improve the risk model for CI-AKI.
造影剂诱导的急性肾损伤（CI-AKI）是ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后常见的并发症。可溶性肿瘤抑制因子2（sST2）与急性肾损伤相关。然而，sST2与CI-AKI之间的关系尚不清楚。本研究旨在探讨STEMI患者中sST2与CI-AKI的关系。
这是一项单中心回顾性观察研究。连续纳入2020年2月至2024年5月在宜春市人民医院诊断为STEMI的患者。CI-AKI定义为造影剂暴露后48 - 72小时内血清肌酐较基线水平至少升高50%或0.3mg/dL。
PCI后CI-AKI的发生率为12.4%（98/791）。单因素分析显示，年龄、空腹血糖、糖尿病、Killip分级、左心室射血分数、估算肾小球滤过率、高敏肌钙蛋白T、N末端B型利钠肽原和sST2与CI-AKI相关。上述因素纳入多因素分析，结果显示sST2是PCI后CI-AKI的独立因素。限制性立方样条图显示sST2与CI-AKI之间存在非线性剂量反应关系（P < 0.001）。纳入sST2可显著提高模型识别CI-AKI的能力（净重新分类指数0.681，95%可信区间0.474 - 0.887；综合判别改善指数0.063，95%可信区间0.038 - 0.099）。
sST2升高是STEMI患者PCI后发生CI-AKI的独立危险因素。纳入sST2可显著改善CI-AKI的风险模型。
