| BackgroundWith the arrival of an aging society,coronary heart disease and chronic kidney disease are frequent and common diseases in the elderly population.The incidence rate is increasing year by year.Percutaneous coronary intervention is currently the most attractive and common revascularization technique for the treatment of coronary heart disease.However,with the increase and complexity of coronary interventions,PCI-related perioperative complications have also attracted more and more attention from clinicians.Contrast induced nephropathy is defined as the absolute increase in serum creatinine?0.5 mg/dl within 48-72 hours after the intravenous or arterial route after the application of contrast agents,excluding prerenal,postrenal,and toxic injury to drugs,or?1.25 times the base value.Studies have shown that the incidence of CIN in the arterial route is significantly higher than that of intravenous CIN,and the mechanism is not clear.Half of CIN occurs secondary to PCI.As the third leading cause of hospital-acquired renal failure,it will not only lead to an increase in economic burden and prolonged treatment time,but also related to long-term adverse events(death,revascularization owing to myocardial ischemia,rehospitalization)are closely related.The incidence of CIN in the general population is low,and in studies aimed at different high-risk populations,the incidence of CIN fluctuates between 30-60%and even higher.Most patients have no effective treatment after CIN.About 1%of CIN progresses to acute renal failure in the hospital and requires further hemodialysis treatment.Therefore,CIN prevention is more impoetant than treatment.Finding early predictors of CIN occurrence is helpful to determine prognosis in advance.It is especially important to take more active prevention strategies for extremely high-risk groups.Chronic kidney disease patients account for 10.8%of all populations,and as the age increases,the larger the proportion,it is a common disease that seriously affects health.Among the many high-risk factors of CIN,chronic renal insufficiency is the most important one.EGFR<60 mlˇmin-1ˇ(1.73 m2)-1 usually indicates a high risk of CIN and significantly increases long-term mortality.Efforts to reduce the incidence of CIN and ensure perioperative safety while ensuring the coronary benefit of patients with chronic kidney disease have been important research directions in the field of coronary heart disease intervention.Scholars generally believe that the occurrence of CIN is the result of a variety of factors,such as the imbalance between vasodilation and vasoconstriction factors caused by contrast agents,blood oxygen deficiency in renal tissue,insufficient perfusion of renal tissue,and cellular Oxidative stress and other joint participation.Among them,the inflammatory response is considered to be an important.link in the development of CIN.Common inflammatory indicators such as monocyte count and C-reactive protein(CRP)were confirmed to be related to CIN.The increased risk of CIN is considered to be related to the former's enhanced inflammation status.Recent Kaplan research indicates that the C-Reactive Protein/Albumin Ratio(CAR)was first proposed.The conclusion indicates that CAR,as a composite indicator,can more sensitively reflect the infection and inflammation status.On the basis of CIN's inflammation theory,we have sufficient reasons to assume that CAR value as a new sensitive indicator of inflammatory status can more accurately reflect the body's inflammatory status and can show a more significant CIN correlation.According to the literature,there is no report on whether CAR is related to CIN after PCI in patients with chronic kidney disease.Chronic renal insufficiency is a common clinical disease,with a high incidence of CIN,and CAR index data is easy to collect.Therefore,this study decided to explore the predictive value of CAR for CIN occurrence in this high-risk population.We look forward to early screening of very high-risk patients and improving their prognosis by adopting more proactive prevention strategies.ObjectiveThe purpose of this study was explore the early predictive value of C-reactive protein to albumin ratio for contrast-induced nephropathy in patients with chronic kidney disease after percutaneous coronary intervention.MethodsFrom June 2018 to December 2019,a total of 215 patients with CKD undergoing elective PCI in the first Affiliated Hospital of Zhengzhou University were enrolled in our retrospective study.The diagnostic criteria for CIN is an increase in serum creatinine(Scr)of more than 44.2 ?mol/L or 25%of the baseline value within 3 days of contrast agent use.Patients with chronic kidney disease treated by PCI were classified according to the development of CIN.They were divided into CIN group(n=27)and no CIN group(n=188)according to having CIN or not.Both groups were compared according to the clinical,and demographic characteristics(age,gender,history of smoking,family history of CHD,hypertension,diabetes mellitus etal.)and laboratory indexes including inflammatory biomarkers and specifically,CAR,echocardiographic parameters.The difference of all indicators between the two groups were compared to analyse the risk factors of CIN.All the dates were analyzed by logistic regression analysis.The receiver operator characteristic curve(ROC)was used to assess the value of CAR for predicting the occurrence of CIN in the patients with CKD.Results1.A total of 215 target patients were included in this study,including 127 males and 88 females.There were 27 cases in CIN group and 188 cases in non-CIN group.The proportion of CIN after PCI was 12.6%.The age,history of diabetes,CRP,and CRP/ALB in the CIN group were higher than those in the non-CIN group.The eGFR and HDL in the CIN group were significantly lower than those in the non-CIN group.There were significant differences between them,and the differences were statistically significant(P<0.05).2.The results of multivariate logistic regression analysis suggest that age,CAR,and CIN after PCI are positively correlated(OR=1.071,95%CI 1.010-1.136,P=0.022)(OR=3.993,95%CI 1.511-10.552,P=0.005),both of which are independent risk factors for CIN,that is,the higher the age,the higher the CAR level,the higher the probability of CIN.3.ROC curve analysis:The areas under the curve where CRP,ALB,and CAR predict CIN after PCI are AUCRP=0.707(95%CI 0.580-0.834),AUCALB=0.614(95%CI:0.501-0.727),and AUCCAR=0.771(95%CI:0.658-0.884),and CAR has a greater predictive diagnostic value for CIN.When the cut-off value is 1.375,the sensitivity of the CAR value to predict the occurrence of CIN aftter PCI in patients with chronic renal insufficiency is 74.1%,and the specificity is 83.0%.That is,the CRP and CAR indicators have better diagnostic value for CIN,the ALB indicator has a general diagnostic efficacy,and the CAR predictive value is better than the CRP indicator.Conclusion1.Increased level of CAR and increased age are the risk factors of the occurrence of CIN in patients with CKD after PCI.The value of the CAR in predicting CIN in patients with CKD is greater than others.It may be a good biomarker for the early diagnosis of CIN.2.In our clinical practice,especially for the patients with chronic kidney disease,when the level of CAR are higher than 1.375,the risk of CIN development is higher in these patients.Early detection of CIN and appropriate manners may reduce the incidence of CIN events. |
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