Effects Of Hyperglycaemia And Elevated Glycosylated Haemoglobin On Contrast-induced Nephropathy After Coronary Angiography

Objective: To investigate the relationship between stress hyperglycemia,elevated glycosylated hemoglobin A1c(HbA1c)and contrast induced nephropathy(CIN).Methods: We randomly selected 258 patients who underwent coronary angiography(CAG)between September 2016 and September 2017.We recorded blood glucose and HbA1 c level of all patients on admission,and divided them into hyperglycaemia group(admission random glucose > 11.1mmol/L,n = 84 cases)and control group(admission random glucose ≤ 11.1mmol/L,n = 174 cases).Patients were divided into high HbA1 c group(HbA1c ≥ 7%,n= 69 cases)and control group(HbA1c< 7%,n= 189 cases)according to the level of HbA1 c.According to CIN diagnostic criteria(serum creatinine increase more than 44.2 μmol/L or 25% after using contrast agent within 48-72 h compared to base serum creatinine level),patients were divided into CIN group(n=45 cases)and control group(n=213 cases).The relationship between stress hyperglycemia and high HbA1 c and contrast induced nephropathy was analyzed.Results: 1.In the stress hyperglycemia group,CIN occurred in 21(25%)patients,while in the control group,CIN occurred in 24(13.8%)patients,statistically significant differences can be seen in CIN incidence between the two groups(P = 0.026).In the elevated HbA1 c group,CIN occurred in 18 cases(26.1%),however,in the control group,CIN occurred in 27 cases(14.3%),there were statistically significant differences in CIN incidence between the two groups(P = 0.039).2.Univariate and binary logistic regression analysis indicated hyperglycemia is an independent risk factor of CIN(OR= 2.815,95%CI=1.042-4.581).HbA1 c was not an independent risk factor for CIN.3.Subgroup analysis showed that,in acute coronary syndrome(ACS)and diabetes subgroup,the CIN incidence rate in the patients with stress hyperglycemia was significantly higher than patients with normal blood glucose.There was no statistical difference in CIN incidence between the stress hyperglycemia group and the control group in the non-ACS and non-diabetic group.4.The receiver operating characteristic curve(ROC)of admission blood glucose predicting CIN indicated the area under the curve(AUC)and 95%CI were 0.569,0.469-0.669.In patients with diabetes,the AUC and 95%CI were 0.652,0.427-0.876.Conclusion: Stress hyperglycemia is an independent risk factor for contrast induced nephropathy.For ACS and diabetes patients with stress hyperglycemia,CIN risk increased significantly.Stress hyperglycemia has certain predictive value for contrast induced nephropathy.