ST segment yükselmeli miyokard enfarktüsü olan hastalarda kontrast maddeye bağlı nefropati ile CANLPH skoru arasındaki ilişki

Abstract

Amaç: Perkütan koroner girişimin (PCI) önemli bir komplikasyonu olan kontrast kaynaklı nefropati (CIN), artmış morbidite ve mortalite ile ilişkilidir. Enflamasyonun CIN gelişiminde önemli bir rol oynadığı ileri sürülmektedir. Bu çalışmanın amacı, PCI uygulanan ST segment yükselmeli miyokard infarktüsü (STEMI) olan hastalarda CIN ve hastane içi mortaliteyi öngörmede inflamasyonun yeni bir göstergesi olan CANLPH skorunun prognostik rolünü araştırmaktı. Materyal ve Metot: Bu retrospektif çalışma, PCI uygulanan STEMI'li 1475 hastayı içermektedir. CIN, PKG'den sonraki 48 saat içinde başlangıç değerine kıyasla serum kreatinin değerinde %25 veya 0,5 mg/dL artış olarak tanımlandı. Her hasta için Mehran skoru hesaplandı. CANLPH skoru, CIN'i tahmin etmek için trombosit/lenfosit oranı, nötrofil/lenfosit oranı ve trombosit/hemoglobin oranının eşik değerlerinden elde edildi. Bulgular: Hastaların ortalama yaşı 62,0 ± 14,3 yıl ve çoğunluğu erkekti (%69,8). CIN insidansı %11,5 olarak belirlendi. Çok değişkenli regresyon analizi, artan CANLPH skorunun (OR = 4,48, p < 0,001) ve artan Mehran skorunun (OR = 1,31, p < 0,001) CIN'in bağımsız belirleyicileri olduğunu gösterdi. CANLPH skorunun CIN'i öngörmedeki eşik değeri %73,5 duyarlılık ve %78,2 özgüllük ile >1 olarak belirlendi. CANLPH skoru CIN ve hastane içi mortaliteyi öngörmede diğer inflamatuar indekslerden daha iyi tanısal performans sergiledi. Sonuç: Planlanan PCI öncesinde CANLPH skoru, CIN ve mortaliteyi öngörmede üstün tanısal performansa sahiptir ve önleyici tedbirler ve tedavi kararları için rehberlik edebilir.

Keywords

• biyobelirteç
• kontrast kaynaklı nefropati
• inflamasyon
• miyokard enfarktüsü

Relationship between contrast media-induced nephropathy and CANLPH score in patients with ST-segment elevation myocardial infarction

Abstract

Aim: Contrast-induced nephropathy (CIN), a significant complication of percutaneous coronary intervention (PCI), is related to increased morbidity and mortality. It has been suggested that inflammation plays an important role in the development of CIN. This study aimed to investigate the prognostic role of the CANLPH score, a new indicator of inflammation, in predicting CIN and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) undergoing PCI. Material and Method: This retrospective study included 1475 patients with STEMI undergoing PCI. CIN was defined as a 25% or 0.5 mg/dL increase in serum creatinine compared to the baseline value within 48 h after PCI. The preprocedural modified Mehran score was calculated for each patient. The CANLPH score was derived from the cut-off points of the platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and platelet/hemoglobin ratio to predict CIN. Results: The mean age of the patients was 62.0±14.3 years and the majority were male (69.8%). The incidence of CIN was determined as 11.5%. Multivariable regression analysis showed that increased CANLPH score (OR=4.49, p<0.001) and increased modified Mehran score (OR=1.27, p<0.001) were independent predictors of CIN. The threshold value of the CANLPH score in predicting CIN was >1 with 73.5% sensitivity and 78.2% specificity and it exhibited better diagnostic performance than other inflammatory indices in predicting CIN and in-hospital mortality. Conclusion: Prior to planned PCI, the CANLPH score has superior diagnostic performance in predicting CIN and mortality, and it may guide decisions about preventive measures and treatments.

Keywords

• Biomarkers
• contrast-induced nephropathy
• inflammation
• myocardial infarction

References

1. Sgura FA, Bertelli L, Monopoli D, et al. Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv 2010; 3: 491-8.
2. Mohammed NM, Mahfouz A, Achkar K, Rafie IM, Hajar R. Contrast-induced Nephropathy. Heart Views 2013; 14: 106-16.
3. Chong E, Poh KK, Liang S, Tan HC. Risk factors and clinical outcomes for contrast-induced nephropathy after percutaneous coronary intervention in patients with normal serum creatinine. Ann Acad Med Singap 2010; 39: 374-80.
4. Kusirisin P, Chattipakorn SC, Chattipakorn N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches. J Transl Med 2020; 18: 400.
5. Altiparmak IH, Tanriverdi Z, Tascanov MB, et al. C-reactive protein/albumin ratio as a novel predictor of contrast induced nephropathy in patients with stable angina pectoris. Angiology 2022; 74: 189-96.
6. Butt K, D’Souza J, Yuan C, et al. Correlation of the neutrophil-to-lymphocyte ratio (NLR) and Platelet-to-lymphocyte ratio (PLR) with contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary interventions. Cureus 2020; 12: e11879.
7. Bao K, Huang H, Huang G, et al. Platelet-to-hemoglobin ratio as a valuable predictor of long-term all-cause mortality in coronary artery disease patients with congestive heart failure. BMC Cardiovasc Disord 2021; 21: 618.
8. Kocas C, Yildiz A, Abaci O, et al. Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in patients with non-st-segment elevation acute coronary syndrome. Angiology 2015; 66: 964-8.

9. Karauzum I, Karauzum K, Hanci K, Gokcek D, Kalas B, Ural E. The utility of systemic immune-inflammation index for predicting contrast-induced nephropathy in patients with st-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiorenal Med 2022; 12: 71-80.
10. Bagci A, Aksoy F, Bas HA. Systemic immune-inflammation index may predict the development of contrast-induced nephropathy in patients with st-segment elevation myocardial infarction. Angiology 2022; 73: 218-24.
11. Komura K, Hashimoto T, Tsujino T, et al. The CANLPH score, an integrative model of systemic inflammation and nutrition status (SINS), predicts clinical outcomes after surgery in renal cell carcinoma: data from a multicenter cohort in Japan. Ann Surg Oncol 2019; 26: 2994-3004.
12. Abacioglu OO, Yildirim A, Koyunsever NY, Ucak HA, Abacioglu S. Relationship between CANLPH score and in-hospital mortality in patients undergoing coronary artery bypass grafting. Biomark Med 2021; 15: 1659-67.
13. Wei X, Chen H, You Z, et al. Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention. Clin Exp Nephrol 2021; 25: 953-62.
14. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Glob Heart 2018; 13: 305-38.
15. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-77.
16. Moro AB, Strauch JGN, Groto AD, Toregeani JF. Creatinine level variation in patients subjected to contrast-enhanced tomography: a meta-analysis. J Vasc Bras 2021; 20: e20200161.
17. Blanco A, Rahim F, Nguyen M, et al. Performance of a pre-procedural Mehran score to predict acute kidney injury after percutaneous coronary intervention. Nephrology (Carlton) 2021; 26: 23-9.
18. Lutz ME. Women, work, and preventive health care: an exploratory study of the efficacy of HMO membership. Women Health 1989; 15: 21-33.
19. Yang Y, George KC, Luo R, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol 2018; 19: 374.
20. Wang W, Qu W, Sun D, Liu X. Meta-analysis of effect of renin-angiotensin-aldosterone system blockers on contrast-induced nephropathy. J Renin Angiotensin Aldosterone Syst 2020; 21: 1470320320919587.
21. Abellas-Sequeiros RA, Raposeiras-Roubin S, Abu-Assi E, et al. Mehran contrast nephropathy risk score: Is it still useful 10 years later? J Cardiol 2016; 67: 262-7.
22. Oweis AO, Alshelleh SA, Daoud AK, Smadi MM, Alzoubi KH. Inflammatory milieu in contrast-induced nephropathy: a prospective single-center study. Int J Nephrol Renovasc Dis 2018; 11: 211-5.
23. Li Y, Ren K. The Mechanism of Contrast-Induced Acute Kidney Injury and Its Association with Diabetes Mellitus. Contrast Media Mol Imaging 2020; 2020: 3295176.
24. Seeliger E, Sendeski M, Rihal CS, Persson PB. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J 2012; 33: 2007-15.
25. Rahim F, Nguyen M, Quach S, Guduru S, Abusaada K. Performance of a Pre-Procedural Mehran Score to Predict Acute Kidney Injury After Percutaneous Coronary Intervention. Circulation 2018; 138: A12186-A.
26. Tourki B, Halade G. Leukocyte diversity in resolving and nonresolving mechanisms of cardiac remodeling. FASEB J 2017; 31: 4226-39.
27. Caiazza A, Russo L, Sabbatini M, Russo D. Hemodynamic and tubular changes induced by contrast media. Biomed Res Int 2014; 2014: 578974.
28. Lu Z, Cheng D, Yin J, et al. Antithrombin III Protects Against Contrast-Induced Nephropathy. EBioMedicine 2017; 17: 101-7.
29. Wang F, Yin J, Lu Z, et al. Limb ischemic preconditioning protects against contrast-induced nephropathy via renalase. EBioMedicine 2016; 9: 356-65.
30. Li Y, Shi D, Zhang H, et al. The application of functional magnetic resonance imaging in type 2 diabetes rats with contrast-induced acute kidney injury and the associated innate immune response. Front Physiol 2021; 12: 669581.
31. Kelesoglu S, Yilmaz Y, Elcik D, et al. Systemic immune inflammation index: a novel predictor of contrast-induced nephropathy in patients with non-ST segment elevation myocardial infarction. Angiology 2021; 72: 889-95.
32. Kelesoglu S, Yilmaz Y, Elcik D, et al. C-reactive protein to albumin ratio as a predictor of contrast-induced nephropathy after carotid angiography. Angiology 2022: 33197221135950.
33. Yilmaz Y, Kelesoglu S, Kalay N. A Novel predictor of contrast-induced nephropathy in patients with carotid artery disease; the systemic immune inflammation index. Angiology 2022; 73: 781-7.