C-Reactive Protein/Albumin Ratio Predicts Acute Kidney Injury in Patients With Moderate to Severe Chronic Kidney Disease and Non-ST-Segment Elevation Myocardial Infarction
Restricted accessResearch articleFirst published online February, 2022
C-Reactive Protein/Albumin Ratio Predicts Acute Kidney Injury in Patients With Moderate to Severe Chronic Kidney Disease and Non-ST-Segment Elevation Myocardial Infarction
In this study, we aimed to evaluate the predictive value of admission C-reactive protein/albumin ratio (CAR) for acute kidney injury (AKI) in cases with moderate to severe chronic kidney disease (CKD) not on dialysis who presented with non-ST-segment elevation myocardial infarction (NSTEMI) and underwent coronary angiography (CAG). This cross-sectional and observational study included 420 NSTEMI patients. The study population was categorized based on the CAR tertiles as groups T1, T2, and T3. The primary outcome of the study was AKI development; 92 (21.9%) cases developed AKI. The frequency of AKI was significantly higher in the T3 group compared with the T2 and T1 groups (34% vs 17% vs 14%, P < .001). Age, estimated glomerular filtration rate, contrast media volume, and CAR (odds ratio: 1.36; 95% CI: 1.17-1.57; P < .01) were significant predictors of AKI. In a receiver operating characteristic curve analysis, CAR levels >0.20 predicted AKI development with a sensitivity of 74% and a specificity of 45%. We observed that the CAR may be a promising inflammatory parameter for AKI in NSTEMI patients with moderate to severe CKD after CAG.
MehranRNikolskyE. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006; 100:11–5.
4.
WadaHDohiTMiyauchiK, et al.Independent and combined effects of serum albumin and C-reactive protein on long-term outcomes of patients undergoing percutaneous coronary intervention. Circ J. 2017; 81:1293–300.
5.
AhmedMSJadhavABHassanA, et al.Acute phase reactants as novel predictors of cardiovascular disease. ISRN Inflamm. 2012; 2012:953461.
6.
RaggiPGenestJGilesJT, et al.Role of inflammation in the pathogenesis of atherosclerosis and therapeutic interventions. Atherosclerosis. 2018; 276:98–108.
7.
YuanYQiuHHuX, et al.Predictive value of inflammatory factors on contrast-induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention. Clin Cardiol. 2017; 40:719–25.
8.
KwasaEAVinayakSArmstrongR. The role of inflammation in contrast-induced nephropathy. Br J Radiol. 2014; 87:20130738.
SchillingerMExnerMMlekuschW, et al.Serum albumin predicts cardiac adverse events in patients with advanced atherosclerosis – interrelation with traditional cardiovascular risk factors. Thromb Haemost. 2004; 91:610–8.
11.
FaircloughECairnsEHamiltonJ, et al.Evaluation of a modified early warning system for acute medical admissions and comparison with C-reactive protein/albumin ratio as a predictor of patient outcome. Clin Med. 2009; 9:30–3.
12.
CınarTCagdasMRencuzogullariI, et al.Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction. Scand Cardiovasc. J2019; 53:83–90.
13.
PrabhuSDFrangogiannisNG. The biological basis for cardiac repair after myocardial infarction: from inflammation to fibro- sis. Circ Res. 2016; 119:91–112.
14.
DaneshJWheelerJGHirschfieldGM, et al.C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004; 350:1387–97.
15.
RoffiMPatronoCColletJP, et al.2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016; 37:267–315.
16.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39: S1–266.
17.
LavilleMJuillardL. Contrast-induced acute kidney injury: how should at-risk patients be identified and managed?J Nephrol. 2010; 23:387.
18.
NeumannFJSousa-UvaMAhlssonA, et al.2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019; 40:87–165.
19.
KnuutiJWijnsWSarasteA, et al.2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41:407–77.
20.
AmsterdamEAWengerNKBrindisRG, et al.2014 AHA/ACC guideline for the management of patients with Non–ST-elevation acute coronary syndromes. J Am Coll Cardiol. 2014;64: e139–228.
21.
ConnollyMMcEneaneyDMenownI, et al.Novel biomarkers of acute kidney injury after contrast coronary angiography. Cardiol Rev. 2015; 23:240–6.
22.
AkcayANguyenQEdelsteinCL. Mediators of inflammation in acute kidney injury. Mediators Inflamm. 2009:137072.
23.
MarenziGCabiatiABertoliSV, et al.Incidence and relevance of acute kidney injury in patients hospitalized with acute coronary syndromes. Am J Med. 2000; 108:187–92.
24.
BruettoRGRodriguesFBTorresUSOtavianoAPZanettaDMBurdmannEA. Renal function at hospital admission and mortality due to acute kidney injury after myocardial infarction. PLoS One. 2012;7: e35496.
25.
ShachamYSteinvilAArbelY.Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol. 2016; 29:169–74.
26.
SunGChenPWangK, et al.Contrast-induced nephropathy and long-term mortality after percutaneous coronary intervention in patients with acute myocardial infarction. Angiology. 2019;70:621–6.
27.
ChenSLZhangJYeiF, et al.Clinical outcomes of contrast-induced nephropathy in patients undergoing per- cutaneous coronary intervention: a prospective, multicenter, randomized study to analyze the effect of hydration and acetylcysteine. Int J Cardiol. 2008; 126:407–13.
28.
KimJHYangJHChoiSH, et al.Predictors of outcomes of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with chronic kidney disease. Am J Cardiol. 2014; 114:1830–5.
29.
KurtulAMuratSNYarliogluesM, et al.Procalcitonin as an early predictor of contrast induced acute kidney injury in patients with acute coronary syndromes who underwent percutaneous coronary intervention. Angiology. 2015; 66:957–63.
30.
MuratSNKurtulAYarliogluesM. Impact of serum albumin levels on contrast-induced acute kidney injury in patients with acute coronary syndromes treated with percutaneous coronary intervention. Angiology. 2015; 66:732–7.
31.
LiLDaiLWangX, et al.Predictive value of the C-reactive protein-to-prealbumin ratio in medical ICU patients. Biomark Med. 2017; 11:329–37.
32.
TanıkVOÇınarTVelibeyY, et al.Neutrophil-to-lymphocyte ratio predicts contrast-induced acute kidney injury in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. J Tehran Heart Cent. 2019; 14:59–66.
33.
KaplanMAtesIAkpinarMY, et al.Predictive value of C-reactive protein/albumin ratio in acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2017; 16:424–30.
34.
TosoALeonciniMMaioliM, et al.Relationship between inflammation and benefits of early high-dose rosuvastatin on contrast-induced nephropathy in patients with acute coronary syndrome: the pathophysiological link in the PRATO-ACS study (protective effect of rosuvastatin and antiplatelet therapy on contrast-induced nephropathy and myocardial damage in patients with acute coronary syndrome undergoing coronary Intervention). JACC: Cardiovasc Interv. 2014; 7:1421–9.
35.
LiuYTanNZhouY-L, et al.High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol. 2011; 25:332–40.
36.
KinoshitaAOnodaHImaiN, et al.The C-reactive protein/albumin ratio, a novel inflammation-based prognostic score, predicts outcomes in patients with hepatocellular carcinoma. Ann Surg Oncol. 2015; 22:803–10.
37.
CagdasMRencuzoǧullariIKarakoyunS, et al.Assessment of relationship between C-reactive protein to albumin ratio and coronary artery disease severity in patients with acute coronary syndrome. Angiology. 2017; 70:361–8.
38.
KarabagYCagdasMRencuzogullariI, et al.The C-reactive protein to albumin ratio predicts acute kidney injury in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Heart Lung Circ. 2019; 28:1638–45.
39.
SatilmisSKarabulutA. Value of C-Reactive Protein/Albumin Ratio in Predicting the Development of Contrast-Induced Nephropathy in Patients With Non-ST Elevation Myocardial Infarction. Angiology. 2020; 71:366–71.
