Significance Of Such Serum And Urinary Biomarkers As NGAL Etc In Early Diagnosis Of Contrast-induced Nephropathy

Objective: To investigate the significance of such serum and urinary biomarkers as NGAL,CysC,KIM-1,IL-18 for the early diagnosis of contrast-induced nephropathy(CIN)in patients undergone cerebral CT angiography(CTA)and / CT perfusion(CTP).Methods: A total of 367 hospitalized patients undergone CTA/CTP was enrolled into this study from May 2015 to February 2017.According to the European Society of Urology and radiology(ESUR)guidelines 2011,CIN was diagnosed in 31 patients(CIN group),and a total of 30 non CIN patients were randomly selected as non-CIN group.Another 30 patients who were hospitalized in department of internal neurology during the same period without contrast media were randomly selected as control group.The changes of serum creatinine(sCr),serum cystatin C(sCysC),plasma neutrophil gelatinaseassociated lipocalin(pNGAL),urinary NGAL(u NGAL),urinary kidney injury molecule-1(uKIM-1)and urinary interleukin-18(u IL-18)were detected before and 8h,24 h and 72 h after CTA/CTP.The same serumand urinary samples were collected at the time of admission in control group.The sensitivity and specificity value of early diagnostic markers for CIN were evaluated by the under area of the receiver operating characteristic(ROC)curves and area under curve(AUC).Results: 1.According to the European Society of Urology and radiology(ESUR)guidelines 2011,CIN was diagnosed in 31 patients(8.4%).2.At 8h after CTA / CTP,the pNAGL,uNGAL,uKIM-1 and uIL-18 levels were significantly increased in the CIN group and the sCysC was increased after 24 h,compared with non-CIN group(P<0.05),earlier change more obvious than Serum creatinine.3.According to ROC curve,the AUC,sensitivity and specificity for 8h sCysC after intravascular injection of contrast media were 0.742,83.9%,56.7%,for 8h pNGAL were 0.975,90.3%,100%,for 8h uNGAL were 0.983,96.8%,100%,for 8h uKIM-1 were 0.809,83.9%,76.7%,for 8h uIL-18 were 0.856,87.1%,90%.The AUC,sensitivity and specificity for 24 h sCysC after intravascular injection of contrast media were 0.896,87.1%,90%,for 24 h pNGAL were 0.984,93.5%,100%,for 24 h uNGAL were 0.988,96.8%,100%,for 24 h uKIM-1 were 0.918,96.8%,96.7%,for 24 h uIL-18 were 0.954,93.5%,100%.The AUC,sensitivity and specificity for 72 h sCysC after intravascular injection of contrast media were 0.946,90.3%,86.7%,for 72 h pNGAL were 0.917,71%,100%,for 72 h uNGAL were 0.919,77.4%,96.7%,for 72 h uKIM-1 were 0.92,87.1%,90%,for 72 h uIL-18 were 0.891,87.1%,96.7%.The biomarkers such as s CysC,pNGAL,uNGAL,uKIM-1,u IL-18 for early diagnosis of CIN are valuable.Urinary NGAL value of early diagnosis of CIN was superior to other biomarkers,most powers of independent forecasts.4.After intravascular injection of contrast media,when combine pNGAL and sCysC,the AUC for 8h,24 h and 72 h were 0.977,0.984,0.962,the sensitivity were 90.3%,93.5%,80.6%,and specificity were 100%,100%,96.7%,respectively.The sensitivity and specificity for early diagnosis of CIN was slightly better than that of NGAL separate diagnosis ability at 72 h after CTA/CTP.The AUC,sensitivity and specificity for early diagnosis of CIN were 0.999,96.8%,100%,when combine uNGAL,uKIM-1 and u IL-18,at 8h after CTA/CTP.AUC for 24 h,72h after contrast media injection approach to 1.0,at this time sensitivity and specificity were 100% respectively.It was significantly higher than the CysC,NGAL,uKIM-1 and uIL-18 in early diagnosis of CIN.5.There was a positive correlation between these biomarkers and sCr(P<0.01).Conclusions: 1.At 8h after CTA/CTP,the sCysC,pNAGL,uNGAL,u KIM-1 and uIL-18 levels were significantly increased in the CIN group.2.The predictable time of CIN onset determined by sCysC,pNGAL,uNGAL,uKIM-1 and u IL-18 were 24-48 h earlierthan sCr,and the sensitivity and specificity is higher in these biomarkers than sCr in early diagnosis of CIN.Especially urine NGAL value of early diagnosis of CIN is superior to other biomarkers,most powers of independent forecasts.3.Combination of uNGAL,uKIM-1 and u IL-18 is more valuable in the sensitivity and specificity of the diagnosis,and can be used as an indicator for early diagnosisof CIN.