Association Between Uric Acid-to-Albumin Ratio and Contrast-Induced Nephropathy and Mortality: An Evaluation in Chronic Total Occlusion Cases

Abstract

Objectives: Among individuals undergoing coronary angiography (CAG), chronic coronary total occlusion (CTO) represents a prevalent lesion type that often requires treatment with percutaneous coronary intervention (PCI). Following PCI, contrast-induced nephropathy (CIN) represents a frequent complication that contributes to elevated morbidity and mortality. The uric acid-to-albumin ratio (UAR) has recently been identified as a novel biomarker linked to unfavorable clinical outcomes. This investigation sought to determine the prognostic significance of UAR for CIN and long-term mortality in CTO patients. Methods: A total of 169 patients managed with PCI for one or more CTO lesions were retrospectively evaluated. Patients were then categorized according to the development of CIN into two groups: CIN-positive (n = 27) and CIN-negative (n = 142). Results: The CIN (+) group demonstrated significantly elevated serum uric acid levels, higher UAR values, and increased mortality rates compared with the CIN (−) group (all p < 0.001). Further multivariate regression analysis established UAR as an autonomous prognostic indicator of CIN (p = 0.012). A UAR cut-off value of 1.77 predicted CIN with 66.7% sensitivity and 62% specificity, while a cut-off of 1.90 predicted long-term mortality with 64.5% sensitivity and 73.9% specificity. According to Kaplan–Meier survival curves, individuals in the CIN-positive group exhibited markedly lower long-term survival and a higher frequency of all-cause death (log-rank, p < 0.001). Conclusion: An increased UAR independently predicted both CIN and long-term mortality in CTO patients, underscoring its prognostic significance in this high-risk population.

Keywords

• Chronic total occlusion (CTO)
• Contrast-Induced Nephropathy (CIN)
• Uric Acid-to-Albumin Ratio (UAR)
• mortality

Ürik Asit-Albumin Oranı ile Kontrast Kaynaklı Nefropati ve Mortalite Arasındaki İlişki: Kronik Total Oklüzyon Olgularında Bir Değerlendirme

Abstract

Amaç: Koroner anjiyografi (CAG) uygulanan bireyler arasında, kronik koroner total oklüzyon (CTO) sık görülen bir lezyon tipini temsil etmekte olup genellikle perkütan koroner girişim (PCI) ile tedavi gerektirmektedir. PCI sonrasında, kontrast kaynaklı nefropati (CIN) sık rastlanan bir komplikasyon olup artmış morbidite ve mortaliteye katkıda bulunmaktadır. Ürik asit-albumin oranı (UAR), son dönemde olumsuz klinik sonuçlarla ilişkili yeni bir biyobelirteç olarak tanımlanmıştır. Bu çalışma, CTO hastalarında UAR’ın CIN ve uzun dönem mortalite açısından prognostik önemini belirlemeyi amaçlamıştır. Yöntemler: Bir veya daha fazla CTO lezyonu nedeniyle PCI uygulanan toplam 169 hasta retrospektif olarak değerlendirildi. Hastalar, CIN gelişimine göre iki gruba ayrıldı: CIN-pozitif (n = 27) ve CIN-negatif (n = 142). Bulgular: CIN (+) grubu, CIN (−) grupla karşılaştırıldığında anlamlı şekilde daha yüksek serum ürik asit düzeyleri, daha yüksek UAR değerleri ve artmış mortalite oranları gösterdi (tümü p < 0,001). Ayrıca, çok değişkenli regresyon analizi UAR’ı CIN için bağımsız bir prognostik gösterge olarak ortaya koydu (p = 0,012). UAR için 1,77 kesme değeri CIN’i %66,7 duyarlılık ve %62 özgüllük ile öngörürken, 1,90 kesme değeri uzun dönem mortaliteyi %64,5 duyarlılık ve %73,9 özgüllük ile tahmin etti. Kaplan–Meier sağkalım eğrilerine göre, CIN-pozitif gruptaki bireyler uzun dönem sağkalım açısından belirgin şekilde daha düşük ve tüm nedenlere bağlı ölüm sıklığı açısından daha yüksek bulundu (log-rank, p < 0,001). Sonuç: Artmış UAR, CTO hastalarında hem CIN’i hem de uzun dönem mortaliteyi bağımsız olarak öngörmüş olup, bu yüksek riskli popülasyonda prognostik önemini vurgulamaktadır.

Keywords

• Kronik total oklüzyon (CTO)
• Kontrast Kaynaklı Nefropati (CIN)
• Ürik Asit-Albumin Oranı (UAR)
• mortalite

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