Neutrophil gelatinase associated lipocalin, an early biomarker for diagnosis of acute kidney injury after percutaneous coronary intervention

2017 ◽  
Vol 43 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Nakhshab Choudhry ◽  
Amna Ihsan ◽  
Sadia Mahmood ◽  
Fahim Ul Haq ◽  
Aamir Jamal Gondal
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Diagnostic Biomarker ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
The Mean

AbstractObjectives:This study was designed to find the reliability of serum NGAL as an early and better diagnostic biomarker than that of serum creatinine for acute kidney injury after percutaneous coronary intervention in Pakistani population.Materials and methods:One hundred and fifty-one patients undergoing elective percutaneous coronary intervention were included and demographic data were recorded. Blood was drawn by venipuncture in clot activator vacutainers and serum was separated and stored at 4°C. Sample was drawn before the percutaneous procedure and subsequently sampling was done serially for 5 days.Results:The mean±SD serum NGAL pre-PCI (39.92± 10.35 μg/L) and 4 h post-PCI (100.42±26.07 μg/L) showed highly significant difference (p<0.001). The mean±SD serum creatinine pre-PCI (70.1±11.8 μmol/L) and post-PCI (71.2±11.6 μmol/L) showed significant difference (p=0.005) on day 2 onwards but mean microalbumin showed insignificant results (p=0.533). The serum NGAL predicted CI-AKI with sensitivity of 95.8% and specificity of 97.6% for a cut off value of 118 μg/L.Conclusion:Our results suggest that NGAL is an excellent early diagnostic biomarker for acute kidney injury in patients undergoing elective percutaneous coronary intervention.

scholarly journals Editor’s Choice- What do small serum creatinine changes tell us about outcomes after acute myocardial infarction?

2017 ◽  
Vol 7 (8) ◽  
pp. 739-742 ◽  
Author(s):  
Johann Auer ◽  
Frederik H Verbrugge ◽  
Gudrun Lamm
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Percutaneous Coronary

Acute kidney injury (AKI), mostly defined as a rise in serum creatinine concentration of more than 0.5 mg/dl, is a common, serious, and potentially preventable complication of percutaneous coronary intervention and is associated with adverse outcomes including an increased risk of inhospital mortality. Recent data from the National Cardiovascular Data Registry/Cath-PCI registry including 985,737 consecutive patients undergoing percutaneous coronary intervention suggest that approximately 7% experienced AKI with a reported incidence of 3–19%. In patients undergoing primary percutaneous coronary intervention for acute myocardial infarction (AMI), AKI occurs more frequently with rates up to 20% depending on patient and procedural characteristics. However, varying definitions of AKI limit comparisons of AKI rates across different studies. Recently, most studies have adopted the Acute Kidney Injury Network (AKIN) criteria for definition and classification of AKI. Beyond the AKIN criteria for AKI, other classifications such as the risk, injury, failure, loss and end-stage kidney disease (RIFLE) and kidney disease: improving global outcomes (KDIGO) criteria are used to define AKI. Notably, even small increases in serum creatinine beyond AKI may be associated with adverse outcomes including increased hospital length of stay and excess. Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary intervention (PCI). Worsening renal function is associated with adverse outcomes including a higher rate of in-hospital mortality. In patients undergoing primary PCI for acute myocardial infarction (AMI), AKI occurs up to 20% of such individuals. Varying definitions of AKI limit comparisons of AKI rates across different studies. Additionally, even small increases in serum creatinine beyond lavels meeting AKI definitions may be associated with adverse outcomes including increased hospital length of stay.

Temporal trends of acute kidney injury in patients undergoing percutaneous coronary intervention over a span of 12 years

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Skalsky ◽  
T Bental ◽  
H Vaknin-Assa ◽  
A Assali ◽  
G Greenberg ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Serum Creatinine ◽  
Temporal Trends ◽  
Early Period ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Late Period ◽  
Percutaneous Coronary ◽  
Over Time

Abstract Background Acute kidney injury (AKI) is a known complication following percutaneous coronary intervention (PCI), and is associated with higher rates of complications. We sought to determine the potential impact of temporal changes on the rates of AKI over time, as well as possible determinants of risk. Methods From a large prospective registry of patients undergoing PCI, 20,032 consecutive patients were assessed at two time periods: 2006–2012 and 2012–2018. Of these, included were cases for which data existed regarding change in creatinine levels from baseline to 48 hours after PCI. AKI was defined according to two methods- a relative elevation of ≥25% in serum creatinine or an absolute elevation of ≥0.5 mg/dL in serum creatinine at 48 hours. Results 15,153 patients were available for final analysis, 7,913 in the first period and 7,240 in the second. Mean age was 65.0y and 66.0y (p&lt;0.01) and baseline creatinine was 1.08 mg/dL and 1.15 mg/dL respectively (p&lt;0.01, table 1). AKI according to 25% relative rise in serum creatinine was documented in 11.1% in the early period and in 7.3% of the patients in the late period, p&lt;0.01. According to the definition of 0.5 mg/dL absolute rise in serum creatinine, respective rates were 3% and 2.9%, p=0.82 (figure 1). Multivariate analysis demonstrated a lower risk of AKI in the late period (OR- 0.72; CI 0.61–0.85, P&lt;0.01). Factors associated with risk of AKI included reduced ejection fraction (OR-0.98; CI 0.976–0.99, p&lt;0.01), older age (OR-1.01; CI 1.005–1.02, p=0.01) and female gender (OR- 1.73; CI 1.46–2.06, p&lt;0.01). Conclusions We have witnessed an improvement in the rates of post-PCI AKI over time. Further research is warranted, to further reduce peri-procedural AKI. Figure 1. Change in the rates of AKI Funding Acknowledgement Type of funding source: None

P5532Predictive value of objective nutritional scores for contrast-induced acute kidney injury in elderly patients undergoing percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Lin ◽  
L Chen ◽  
L Chen ◽  
C Han ◽  
C Han ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Nutritional Status ◽  
Elderly Patients ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Left Ventricular Ejection ◽  
Percutaneous Coronary ◽  
Conut Score

Abstract Background Age >75 years had been generally considered to be an important and independent risk factor of contrast-induced acute kidney injury (CI-AKI), while these patients often suffer from malnutrition. However, the predictive value of objective nutritional status for CI-AKI in elderly patients undergoing percutaneous coronary intervention (PCI) remains unknown. Purpose To evaluate the association of two kinds of objective nutritional indices includes controlling nutritional (CONUT) score and prognostic nutritional index (PNI) with CI-AKI in elderly patients undergoing PCI. Methods In a single center prospective cohort study,we enrolled 714 consecutive patients who aged >75 years undergoing PCI between January 2012 and December 2015 were screened based on their serum albumin, lymphocyte count, and total cholesterol measures. Patients were stratified into different groups according to two kinds of objective nutritional scores. Patients were divided into low-PNI (PNI <35), middle-PNI (35 ≤ PNI <38), and high-PNI (PNI ≥38). They were also divided into four groups according to CONUT score: normal-CONUT (0–1), mild-CONUT (2–4), moderate-CONUT (5–8), and severe-CONUT (≥9). CI-AKI was defined as an increase in the serum creatinine levels of ≥50% or 0.3 mg/dL above the baseline level within 48hrs after contrast medium exposure. Results Overall, 55 (7.7%) had moderate-severe CONUT scores, and 35 (4.9%) had low-middle PNI scores,while 93 (13.0%) patients developed CI-AKI. Patients with a lower PNI score or higher CONUT score had significantly higer incidence of CI-AKI [PNI score: high (11.8%), middle (33.3%), and low (45.5%), respectively; P<0.0001; CONUT score: normal (9.6%), mild (12.7%), moderate (30.2%), and severe (100%), respectively; P<0.0001]. After adjusting 6 confounders, including age, serum creatinine (SCR) >1.5mg/dl, left ventricular ejection fraction (LEVF) <45%, myocardial infarction, peri-hypotension and the contrast volume >200 ml, multivariate analysis showed that worse objective nutritional status (either lower PNI scores or higer CONUT scores) was associated with an increased CI-AKI risk (Low PNI vs High PNI: OR: 5.274, P=0.015; Moderate-Severe CONUT vs Normal CONUT: OR: 2.891, P=0.007). Incidence of CIAKI Conclusions Worse objective nutritional status was associated with CI-AKI in elderly patients after PCI.

scholarly journals Overconsumption of Contrast Media in Percutaneous Coronary Intervention: Focusing on Cost and Acute Kidney Injury

2019 ◽  
Author(s):  
Marziye Jafari ◽  
Gohar Eslami ◽  
Babak Bagheri ◽  
Shirin Asghari Vaskasi ◽  
Shafagh Eslami
Keyword(s):  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Contrast Media ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Evaluation Study ◽  
Elective Percutaneous Coronary Intervention ◽  
Percutaneous Coronary ◽  
Standard Values ◽  
Periodic Evaluation

Irrational use of medicines is a major problem worldwide. Since iodixanol (Visipaque®) was categorized in Category I based on the ABC-VED analysis in our hospital, we evaluated the amount of visipaque use and estimated the incremental cost based on the Maximum Contrast Dose (MCD) following irrational use of contrast media. This retrospective study was conducted on 100 admitted patients aged 18 to 80 years old undergoing elective Percutaneous Coronary Intervention (PCI) who received visipaque during February 2016 to January 2017. All of the patients’ information was collected from medical records and Hospital Information System (HIS). MCD was calculated by using the formula proposed by Cigarroa and colleagues: MCD (mL) =5× body weight (kg)/ Serum Creatinine (SCr) (mg/dl). The amount of contrast media administered ranged from 200 to 600 mL (mean, 348 mL ± 80). 57 % of patients received the visipaque more than MCD. Only 25 patients were evaluated SCr after PCI and in 11 (44%) of these patients SCr increased and 3 (12%) patients developed CI-AKI. Consumption of the contrast media was 2 to 3 times more than previous studies which could be the cause of acute kidney injury besides the extra cost. In our study about six liters more of contrast agent was used which is more than standard values with a cost of approximately $2,000 for 100 patients. Therefore, in order to reduce costs and complications, appropriate clinical protocol of contrast media, more supervision on medical residents and contrast infusion pumps, as well as a periodic evaluation study are highly recommended.

scholarly journals Assessment of the influence of different factors on the risk of the development of a new coronavirus infection in patients with contrast induced acute kidney injury

2021 ◽  
Vol 93 (6) ◽  
pp. 667-671
Author(s):  
Georgy O. Isaev ◽  
Olga Iu. Mironova ◽  
Viktor V. Fomin
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Percutaneous Coronary Intervention ◽  
Renal Replacement Therapy ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
Coronavirus Infection

Aim. The main aim of our study was to assess the role of risk factors in patients with previous contrast induced acute kidney injury (CI-AKI) on a probability of a development of the new coronavirus infection. Materials and methods. Our study includes 65 patients with the history of CI-AKI after coronary angiography from 2013 to 2017 years; 10 of them had a new coronavirus infection, which had developed before November 2020. CI-AKI was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dl or more in serum creatinine from baseline value, assessed at 48 hours following the administration of the contrast. The primary endpoint was the development of a new coronavirus infection. Results. We found statistically significant difference in the prevalence of the allergic reaction to iodine (р=0.0178) between non-COVID and COVID-patients group. Also, there were statistically significant differences in the secondary endpoints: renal replacement therapy (р=0.0178) and repeated percutaneous coronary intervention in the last year (р=0.0112) were more common among patients with coronavirus. The difference in the prevalence of arterial hypertension was near to statistical significance (р=0.0882). Conclusion. COVID-patients with CI-AKI had more allergic reactions to iodine than non-COVID patients. The trend of more common arterial hypertension between COVID-patients was found in our research. There were not any statistical significant differences in other risk factors. There were statistically significant difference in the secondary endpoints such as repeated percutaneous coronary intervention and renal replacement therapy. Other endpoints didnt show a statistically significant difference.

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