Platelet-to-lymphocyte ratio predicts contrast-induced nephropathy in acute myocardial infarction

Öz

Aim: Contrast-induced nephropathy (CIN) is responsible for an increased mortality rate and correlates with increases in hospital stays and the risk of cardiovascular complications. The platelet to lymphocyte ratio (PLR) was introduced as a potential marker to determine the balance between thrombosis and inflammation and was associated with increased cardiovascular morbidity and mortality. We investigated whether PLR on admission is an independent risk factor that predicts the development of CIN in patients with ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (pPCI).

Material and Methods: 1348 consecutive patients with acute STMI who were admitted to our institution and underwent pPCI were retrospectively evaluated. Data obtained from hospital files and computer records. CIN development was accepted as the endpoint.

Results: A total of 127 (9.4%) patients experienced CIN. 16 patients underwent renal replacement theraphy. In-hospital mortality rate was found 2.7% (n = 37). Patients were divided into two groups based on development of CIN. Age (P = 0.001), baseline GFR (P < 0.001), grade 3 and more chronic kidney disease (P < 0.001), baseline creatinin (P < 0.001), EF (P < 0.001), presence of DM (P < 0.001) were different between groups. In multivariate analyses, PLR (odds ratio [OR] 1.012, 95% confidence interval [CI] 1.006-1.017, P < 0.001) was independently predicted CIN development.

Conclusion: PLR is easily available, widely used, and relatively cheap biomarker, and is an independent predictor of CIN development in patients with STEMI undergoing pPCI.

Anahtar Kelimeler

• Platelet/lymphocyte ratio,ST-segment elevation acute myocardial infarction,contrast-induced nephropathy

Akut miyokard infarktüsünde trombosit/lenfosit oranı kontrast nefropatisini öngörür

Öz

Amaç: Kontrast madde nefropatisi (CIN) uzamış hastanede yatış süresi, artmıs kardiyovasküler komplikasyonlar ve mortalite ile ilişkilidir. Trombosit/lenfosit oranı (PLR) tromboz ve inflamasyon arasındaki dengeyi gösteren potansiyel bir belirteç olarak tanımlanmış ve artan kardiyovasküler morbidite ve mortalite ile ilişkili bulunmuştur. Biz bu çalışmada PLR’nin primer perkütan koroner girişim (pPCI) yapılan ST yükselmeli miyokard infarktüsü (STEMI) hastalarda CIN gelişimini tahmin etmede bağımsız bir risk faktörü olup olmadığı araştırdık.

Gereç ve Yöntemler: Kurumumuza akut STEMI ile başvuran ve pPCI yapılan 1348 hasta geriye dönük olarak değerlendirildi. Hastane dosya ve bilgisayar kayıtlarından veriler elde edildi. CIN gelişimi sonlanım noktası olarak kabul edildi.

Bulgular: 127 (%9.4) hastada CIN gelişmişti. 16 hastaya renal replasman tedavisi uygulandı. Hastane içi mortalite oranı %2,7(n = 37) bulunmuştur. Hastalar CIN gelişimine göre iki gruba ayrıldı. Yaş (P = 0,001), bazal GFR (P < 0,001), grade 3 ve üzeri kronik böbrek hastalığı (P < 0,001), bazal kreatinin (P < 0,001), EF (P < 0,001), DM varlığı (P < 0,001) gruplar arasında farklı idi. Çok değişkenli analizlerde, PLR (odds ratio [OR] 1.012, %95 güven aralığı [CI] 1,006-1,017, P < 0,001) CIN gelişimini bağımsız olarak öngördü.

Sonuçlar: PLR, kolay ulaşılabilir yaygın olarak kullanılan ve nispeten ucuz biyomarkerdir ve STEMI nedeniyle pPCI uygulanan hastalarda CIN gelişiminin bağımsız bir belirleyicisidir.

Anahtar Kelimeler

• Trombosit/lenfosit oranı,ST yükselmeli miyokard infarktüsü,kontrast madde nefropatisi

Kaynakça

1. 1. McCullough PA, Adam A, Becker CR, et al. CIN Consensus Working Panel. Epidemiology and prognostic implications of contrast induced nephropathy. Am J Cardiol. 2006; 98: 5-13.
2. 2. Lazaros G, Tsiachris D, Tousoulis D, et al. In-hospital worsening renal function is an independent predictor of one-year mortality in patients with acute myocardial infarction. Int J Cardiol 2012; 155: 97-101.
3. 3. Temiz A, Gazi E, Gungor O, et al. Platelet/lymphocyte ratio and risk in-hospital mortality in patients with ST-elevated myocardial infarction. Med Sci Monit 2014; 22: 660-5.
4. 4. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-470.
5. 5. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63: 2889-934.
6. 6. Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl 2006; 100: 11e15.
7. 7. Chen YL, Fu NK, Xu J, et al. A simple preprocedural score for risk of contrast-induced acute kidney injury after percutaneous coronary intervention, Catheter Cardiovasc Interv. 2014; 83:8-16.
8. 8. Abaci O, Arat Ozkan A, Kocas C, et al. Impact of Rosuvastatin on contrast-induced acute kidney injury in patients at high risk for nephropathy undergoing elective angiography. Am J Cardiol. 2015; 115: 867-71.

9. 9. 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.
10. 10. Wong PC, Li Z, Guo J, Zhang A. Pathophysiology of contrast-induced nephropathy, Int J Cardiol 2012; 158: 186-192.
11. 11. Liu Y, Tan N, Zhou YL, et al. High sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol 2012; 25: 332-340.
12. 12. Ruparelia N, Digby JE, Jefferson A, et al. Myocardial infarction causes inflammation and leukocyte recruitment at remote sites in the myocardium and in the renal glomerulus. Inflamm Res. 2013; 62: 515-25.
13. 13. Cicek G, Acıkgoz SK, Bozbay M, et al. Neutrophil-lymphocyte ratio and plateletlymphocyte ratio combination can predict prognosis in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology 2015; 66: 441-7.
14. 14. Gawaz M, Langer H, May AE. Platelets in inflammation and atherogenesis. J Clin Invest 2005; 115: 3378-84.
15. 15. Nyman U, Aspelin P, Jakobsen J, et al. Controversies in Contrast Material-induced Acute Kidney Injury: Propensity Score Matching of Patients with Different Dose/Absolute Glomerular Filtration Rate Ratios. Radiology. 2015; 277: 633-7.
16. 16. Akbas EM, Demirtas L, Ozcicek A, et al. Association of epicardial adipose tissue, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with diabetic nephropathy. Int J Clin Exp Med. 2014,15:1794-801.