Kontrast ilişkili akut böbrek hasarı ve Direct Bilirubin Düzeyleri Arasındaki İlişki

Year 2021, Volume: 5 Issue: 3, 244 - 249, 31.12.2021

Yasemin Kaya , Ahmet Kaya , Ahmet Karataş , Osman Bektaş , Mustafa Yenerçağ , Fatih Akkaya

https://doi.org/10.30565/medalanya.887847

Abstract

Amaç: Bu çalışmada akut koroner sendromlu (AKS) hastalarda antioksidatif, anti-inflamatuar ve antitrombotik etkileri olduğu bilinen bilirubin düzeyleri ile kontrast ile ilişkili akut böbrek hasarı (KI-ABH) arasındaki ilişkiyi araştırmayı amaçladık.

Yöntemler: 2017-2020 tarihleri arasında AKS tanısı ile perkütan anjioplasti yapılan, dışlama ve dahil edilme kriterlerine uyan ardışık 18 yaş üstü hastalar (n:514) retrospektif olarak tarandı. Hastaların yaş, cinsiyet, kronik hastalıkları, tam kan sayımı parametreleri, kontrast öncesi ve kontrast verildikten 48 saat sonraki biyokimyasal parametreleri kaydedildi. Kontrast ile ilişkili akut böbrek hasarı tanısı kontrast uygulandıktan 48 saat sonraki serum kreatininde bazal kreatinine göre %25 artış olarak tanımlandı.

Bulgular: Kadınlarda KI-ABH oranı daha yüksek bulundu (p=0.011). Hastalar KI-ABH pozitif ve negatif olmak üzere iki gruba ayrıldı. KI-ABH pozitif hasta grubunun yaş ortalaması anlamlı olarak daha yüksek (p= 0.04), Hemoglobin (p=0.007) ve direkt bilirubin (p=0.008) düzeyleri anlamlı olarak daha düşük bulundu. KI-ABH’nın bağımsız öngördürücüleri tespit etmek amacıyla yaptığımız istatistiksel analizi sonucunda direkt bilirubin (Beta: 0,051 OR (95% Cl 0,007/0,392 p=0,004) bir öngördürücü olarak bulundu. Direkt Bilirubin 0.065 değerinin %90 sensivite ve %91 spesivite ile KI-ABH ‘nı öngördürdüğü tespit edildi.

Sonuç: KI-ABH pozitif hasta grubunda direkt bilirubin düzeylerinin anlamlı olarak daha düşük olduğu ve Direkt Bilirubin 0.065 değerinin %90 sensivite ve %91 spesivite ile KI-ABH ‘nı öngördürdüğü bulunmuştur.

Keywords

kontrast nefropati, direkt bilirubin, bilirubinler

The association between contrast associated acute kidney injury and direct bilirubin levels

Abstract

Aim: In this study we aimed to association between bilirubin levels, which is known to have anti-oxidative, anti-inflammatory and anti-thrombotic effects, and contrast associated acute kidney injury (CA-AKI) in patients with acute coronary syndrome (ACS).

Methods: Between 2017-2020, consecutive patients over 18 years of age who applied percutaneous angioplasty with the ACS diagnosis and met the exclusion and inclusion criteria (n:514) were retrospectively screened. Age, gender, chronic diseases and complete blood count parameters of the cases were recorded. Biochemical parameters, before applying contrast and 48 hours after applying contrast, were recorded. A 25% increase in creatinine level measured 48 hours after contrast application compared to basal creatinine was defined as CA-AKI.

Results: CA-AKI rate was higher in females(p=0.011). In the CA-AKI positive patient group, the mean age was found significantly higher (p=0.04), hemoglobin (p=0.007), direct bilirubin (p=0.008) levels were found significantly lower. Direct bilirubin was found to be a predictor as a result of our statistical analysis to identify independent predictors of CA-AKI (Beta:0.051 OR 95% CI:0.007-0.392, p=0.004). It was found that the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.

Conclusion: It was observed that the direct bilirubin values were significantly lower in the CA-AKI positive patient group, and the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.

Keywords

contrast nephropathy, direct bilirubin, bilirubins

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