Naples prognostik skoru, primer perkütan koroner girişim uygulanan akut koroner sendrom hastalarında akut böbrek hasarını öngörür

Abstract

Amaç: Akut böbrek hasarı (ABH), akut koroner sendrom (AKS) nedeniyle perkütan koroner girişim (PKG) uygulanan hastalarda sık görülen bir komplikasyondur. Enflamatuar ve beslenme ile ilişkili belirteçleri birleştiren Naples Prognostic Score (NPS), ABH riski yüksek hastaların belirlenmesine yardımcı olabilir. Bu çalışma, PKG uygulanan AKS hastalarında NPS’nin ABH öngörüsündeki değerini değerlendirmeyi amaçladı. Yöntem: PKG ile tedavi edilen 1360 AKS hastasını retrospektif olarak analiz ettik. ABH, işlemden sonraki 48–72 saat içinde serum kreatinin düzeyinde ≥0.5 mg/dL ya da ≥%25 artış olarak tanımlandı. NPS; serum albümin, total kolesterol, nötrofil/lenfosit oranı (NLR) ve lenfosit/monosit oranı (LMR) kullanılarak hesaplandı. Hastalar, NPS’ye göre düşük risk (0–2) ve yüksek risk (3–4) gruplarına ayrıldı. Lojistik regresyon ve ROC analizleri uygulandı. Bulgular: ABH, 221 hastada (%16,3) gelişti. ABH gelişen hastalar daha yaşlıydı ve diyabet, kalp yetersizliği ve LAD tutulum oranları daha yüksekti. Çok değişkenli analizde, yüksek NPS, diyabet ve kalp yetersizliği ile birlikte ABH ile bağımsız olarak ilişkiliydi (OR = 4.127, %95 GA: 4.008–4.460, p < 0.001). NPS, ABH için iyi bir öngörücü performans gösterdi (EAA = 0.823) ve albümin, kolesterol, NLR ve LMR gibi bireysel bileşenlerinden daha üstün bulundu. Sonuç: NPS, PKG uygulanan AKS hastalarında ABH’yi öngörmede basit ve etkili bir araçtır. Klinik uygulamada erken risk sınıflandırmasına katkı sağlayabilir ve önleyici stratejilere yön verebilir.

Keywords

• akut koroner sendrom
• akut böbrek hasarı
• Naples prognostik skoru
• perkütan koroner girişim
• inflamasyon

Naples prognostic score predicts acute kidney injury in acute coronary syndrome patients undergoing primary percutaneous coronary intervention

Abstract

Aims: Acute kidney injury (AKI) is a frequent complication in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The Naples prognostic score (NPS), which integrates inflammatory and nutritional markers, may improve identification of patients at higher risk for AKI. This study aimed to evaluate the predictive value of NPS for AKI in ACS patients undergoing PCI. Methods: We retrospectively analyzed 1360 ACS patients treated with PCI. AKI was defined as an increase in serum creatinine ≥0.5 mg/dl or ≥25% from baseline within 48–72 hours after the procedure. NPS was calculated using serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Patients were categorized into low-risk (NPS 0–2) and high-risk (NPS 3–4) groups. Logistic regression and ROC analysis were performed. Results: AKI occurred in 221 patients (16.3%). Patients with AKI were older and had higher rates of diabetes, heart failure (HF), and LAD involvement. In multivariate analysis, high NPS was independently associated with AKI (OR=4.127, 95% CI: 4.008–4.460, p<0.001), along with diabetes and HF. NPS showed good predictive ability (AUC=0.823), outperforming albumin, cholesterol, NLR, and LMR individually. Conclusion: NPS is a simple and effective tool to predict AKI in ACS patients undergoing PCI. It may aid in early risk stratification and guide preventive strategies in clinical practice.

Keywords

• Acute coronary syndrome
• acute kidney injury
• Naples prognostic score
• percutaneous coronary intervention
• inflammation

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