AlHammouri Hashim M, Mustafa Osama, Mash'al Nour, Suwan Siya, Al-Rababa'h Mohammad, Turk Ahmad Z, Toubasi Ahmad
Faculty of Medicine, University of Jordan, Amman, Jordan.
Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
Catheter Cardiovasc Interv. 2025 Aug 5. doi: 10.1002/ccd.70056.
Contrast-induced nephropathy (CIN) is a serious complication after percutaneous coronary intervention (PCI), especially in acute coronary syndrome (ACS) patients. While risk factors are known, predicting CIN remains difficult. New biomarkers like the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are gaining attention as potential predictors due to their links with inflammation and coagulation.
This meta-analysis examines whether NLR and PLR can predict CIN risk in PCI patients with ACS, aiming to clarify their diagnostic value.
We analyzed data from 25 studies with 25,505 patients, looking at the link between preprocedural NLR and PLR and CIN risk. We calculated odds ratios (OR), sensitivity, specificity, and area under the curve (AUC) values to assess diagnostic accuracy.
A total of 25,505 patients from 25 studies were included. Elevated preprocedural NLR and PLR were significantly associated with increased CIN risk. In the ACS population, 15 studies demonstrated that NLR was significantly associated with increased odds of CIN, with a pooled OR of 1.21 (95% confidence interval (CI): 1.12 to 1.30, p < 0.001). Receiver operating characteristic analysis showed moderate sensitivity (72%), specificity (60%), and an AUC of 71%. Similar trends were observed in ST-segment elevation myocardial infarction (STEMI). The non-STEMI (NSTEMI) subgroup showed a stronger association, with a pooled OR of 2.03 (95% CI: 1.13 to 3.65, p = 0.02), moderate to good diagnostic accuracy (AUC 79%), and higher sensitivity (77%) and specificity (73%). For PLR, significant associations with CIN were found in the ACS population (OR: 1.16, 95% CI: 1.04 to 1.30, p = 0.007), with moderate diagnostic accuracy (AUC: 0.67, 95% CI: 0.61 to 0.73). In the STEMI population, PLR was also significantly associated with CIN (OR: 1.34, 95% CI: 1.14 to 1.57, p < 0.001), but diagnostic accuracy was lower (AUC: 0.66, 95% CI: 0.59 to 0.74). Limited data from the NSTEMI population showed a moderate association (AUC: 0.68, 95% CI: 0.64 to 0.72), indicating fair diagnostic accuracy.
Preprocedural NLR and PLR are simple, cost-effective biomarkers for predicting CIN risk in ACS, especially among NSTEMI patients undergoing PCI. These markers can facilitate earlier identification of high-risk patients and enable targeted preventive strategies. However, their moderate diagnostic performance highlights the need for the development of more specific and sensitive biomarkers.
造影剂肾病（CIN）是经皮冠状动脉介入治疗（PCI）后的一种严重并发症，尤其是在急性冠状动脉综合征（ACS）患者中。虽然已知一些危险因素，但预测CIN仍然困难。中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）等新的生物标志物因其与炎症和凝血的关联，作为潜在预测指标正受到关注。
本荟萃分析探讨NLR和PLR是否可预测ACS患者PCI术后发生CIN的风险，旨在阐明其诊断价值。
我们分析了来自25项研究的25505例患者的数据，观察术前NLR和PLR与CIN风险之间的关联。我们计算了比值比（OR）、敏感性、特异性和曲线下面积（AUC）值以评估诊断准确性。
共纳入来自25项研究的25505例患者。术前NLR和PLR升高与CIN风险增加显著相关。在ACS人群中，15项研究表明NLR与CIN发生几率增加显著相关，合并OR为1.21（95%置信区间（CI）：1.12至1.30，p＜0.001）。受试者工作特征分析显示其敏感性为中等（72%）、特异性为60%，AUC为71%。在ST段抬高型心肌梗死（STEMI）中观察到类似趋势。非ST段抬高型心肌梗死（NSTEMI）亚组显示出更强的关联，合并OR为2.03（95%CI：1.13至3.65，p = 0.02），诊断准确性为中等至良好（AUC 79%），敏感性较高（77%），特异性较高（73%）。对于PLR，在ACS人群中发现其与CIN显著相关（OR：1.16，95%CI：1.04至1.30，p = 0.007），诊断准确性中等（AUC：0.67，95%CI：0.61至0.73）。在STEMI人群中，PLR也与CIN显著相关（OR：1.34，95%CI：1.14至1.57，p＜0.001），但诊断准确性较低（AUC：0.66，95%CI：0.59至0.74）。NSTEMI人群的有限数据显示出中等关联（AUC：0.68，95%CI：0.64至0.72），表明诊断准确性尚可。
术前NLR和PLR是预测ACS患者CIN风险的简单、经济有效的生物标志物，尤其是在接受PCI的NSTEMI患者中。这些标志物有助于更早识别高危患者并实施有针对性的预防策略。然而，它们中等的诊断性能凸显了开发更特异、更敏感生物标志物的必要性。
