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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. 1.Guzel T, Bilik MZ, Arslan B, et al. The effect ofatherogenic plasma index on collateral development inpatients with chronic coronary total occlusion. ExpBiomed Res. 2021;4(4):291-301.
2. 2.Jeroudi OM, Alomar ME, Michael TT, et al. Prevalenceand management of coronary chronic total occlusions ina tertiary Veterans Affairs hospital. Catheter CardiovascInterv. 2014;84(4):637-43.
3. 3.Fefer P, Knudtson ML, Cheema AN, et al. Currentperspectives on coronary chronic total occlusions: theCanadian Multicenter Chronic Total Occlusions Registry. J Am Coll Cardiol. 2012;59(11):991-7.
4. 4. Gierlotka M, Tajstra M, Gasior M, et al. Impact of chronictotal occlusion artery on 12-month mortality in patientswith non ST-segment elevation myocardial infarctiontreated by percutaneous coronary intervention (from the PL-ACS Registry). International journal of cardiology2013, 168:250-4.
5. 5. Zuo T, Jiang L, Mao S, et al. Hyperuricemia and contrast-induced acute kidney injury: a systematic review andmeta-analysis. Int J Cardiol. 2016;224:286-94.
6. 6.Mehran R, Aymong ED, Nikolsky E. et al. A simple riskscore for prediction of contrast-induced nephropathyafter percutaneous coronary intervention: developmentand initial validation. J Am Coll Cardiol 2004; 44: 1393.
7. 7.Mendi MA, Afsar B, Oksuz F, et al. Uric acid is a usefultool to predict contrast-induced nephropathy. Angiology.2017 Aug;68(7):627-32.
8. 8.Choi H, Kim Y, Kim SM, et al. Intravenous albumin forthe prevention of contrast-induced nephropathy inpatients with liver cirrhosis and chronic kidney diseaseundergoing contrast enhanced CT. Kidney Res Clin Pract.2012 Jun;31(2):106-11.

9. 9.Ertas F, Avci E, Kiris T. The ratio of fibrinogen toalbumin as a predictor of contrast-induced nephropathyafter carotid angiography. Angiology. 2019May;70(5):458-64.
10. 10.Şaylık F, Çınar T, Akbulut T, et al. Serum uric acid toalbumin ratio can predict contrast-induced nephropathyin ST-elevation myocardial infarction patientsundergoing primary percutaneous coronary intervention. Angiology. 2023 Jan;74(1):70-8.
11. 11. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney IntSuppl. 2006;100(100): S11-S15.
12. 12.Aydın C, Emlek N. The relationship between uric acidto high-density lipoprotein cholesterol ratio andcollateral index in patients with chronic total occlusion.Kardiologiia. 2021;61(9):61-5.
13. 13.Kasapkara HA, Topsakal R, Yarlioglues M, et al. Effectsof serum uric acid levels on coronary collateralcirculation in patients with non-ST elevation acutecoronary syndrome. Coron Artery Dis. 2012;23(7):421-5.
14. 14.Kanbay M, Jensen T, Solak Y, et al. Uric acid inmetabolic syndrome: from an innocent bystander to acentral player. Eur J Intern Med. 2016;29:3-8.
15. 15.Caiazza A, Russo L, Sabbatini M, et al. Hemodynamicand tubular changes induced by contrast media. BiomedRes Int 2014;2014:578974.
16. 16.Evsen A, Aktan A, Kılıç R, et al. The Predictive Value ofthe CHA₂DS₂-VASc Score in the Development of Contrast-Induced Nephropathy After Endovascular Intervention in Peripheral Artery Disease. Ann Vasc Surg. 2025Jul:116:17-26.
17. 17. Mende C. Management of Chronic Kidney Disease: The Relationship Between Serum Uric Acid and Developmentof Nephropathy. Adv Ther (2015) 32:1177–91.
18. 18.Kim HJ. Association Between Hyperuricemia andDehydration in Children With Acute Gastroenteritis.Pediatr Emerg Care. 2025 Oct 23. Online ahead of print.
19. 19.Roche M, Rondeau P, Singh NR, et al. The antioxidantprop erties of serum albumin. FEBS Lett. 2008;582:1783-7.
20. 20.Sheinenzon A, Shehadeh M, Michelis R, et al. Serumalbumin levels and inflammation. Int J Biol Macromol.2021;184:857-62.
21. 21.Kwasa EA, Vinayak S, Armstrong R. The role ofinflammation in contrast-induced nephropathy. Br JRadiol. 2014 Sep;87(1041):20130738.
22. 22.Şaylık F, Çınar T, Akbulut T, et al. Serum uric acid toalbumin ratio can predict contrast-induced nephropathyin ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Angiology2023;74: 70-8.
23. 23.Demirci G, Şahin AA, Altunova M, et al. The effect ofuric acid and albumin ratio in undergoing lowerextremity endovascular interventions for peripheralarterial disease related contrast induced nephropathy.Ann Vasc Surg. 2024 Nov:108:452-8.
24. 24. Yeter HH, Eyupoglu D, Pasayev T, et al. Role of uric acid albumin ratio in predicting development of acute kidneyinjury and mortality in intensive care unit patients. TurkJ Nephrol. 2019;28:160-7.
25. 25. Kalkan S, Cagan Efe S, Karagöz A, et al. A new predictor of mortality in ST-elevation myocardial infarction: theuric acid albumin ratio. Angiology. 2022;73(5):461-9.
26. 26.Wang X, Deng C, Guo F, et al. The preoperative uricacid-to albumin ratio as a new indicator to predict long-term prognosis after surgery for patients with acute typeA aortic dissection. Heart Surg Forum. 2023 Jan9;26(1):E001-E008.
27. 27.Ozgür Y, Akın S, Yılmaz NG, et al. Uric acid albuminratio as a predictive marker of short-term mortality inpatients with acute kidney injury. Clin Exp Emerg Med.2021;8:82-8.
28. 28. Güzel T, Aktan A, Demir M, et al. Relationship betweencontrast-induced nephropathy and long-term mortalityafter percutaneous coronary intervention in patients withchronic coronary total occlusion. Rev Assoc Med Bras(1992). 2022 Aug;68(8):1078-83.
29. 29.James MT, Ghali WA, Knudtson ML, et al. Associationsbetween acute kidney injury and cardiovascular andrenal outcomes after coronary angiography. Circulation.2011;123(4):409-16.
30. 30. Andò G, de Gregorio C, Morabito G, et al. Renal function adjusted contrast volume redefines the baselineestimation of contrast-induced acute kidney injury risk in patients undergoing primary percutaneous coronaryintervention. Circ Cardiovasc Interv 2014;7:465-72.
31. 31.Lee SR, Zhuo H, Zhang Y, et al. Risk factors and safecontrast volume thresholds for postcontrast acute kidneyinjury after peripheral vascular interventions. J Vasc Surg2020;72: 603-610.e1.
32. 32.Aspelin P, Aubry P, Fransson SG, et al. Nephrotoxicityin High-Risk Patients Study of Iso-Osmolar and Low-Osmolar Non-Ionic Contrast Media Study Investigators.Nephrotoxic ef fects in high-risk patients undergoingangiography. N Engl J Med. 2003 Feb 6;348(6):491-9.