The Role of Serum Cystatin C in the Early Detection of Contrast-Induced Nephropathy after Coronary Intervention (original) (raw)
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Acta medica academica, 2017
This study aimed to test the association of both the baseline values and post-procedural variations of urinary and serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C (CysC) with contrast induced nephropathy (CIN) occurrence in patients undergoing percutaneous coronary invasive procedures (PCIP), and compare them to serum creatinine and the estimated glomerular filtration rate (eGFR). In 43 patients admitted to our Cardiac Step-Down Unit and submitted to PCIP, we measured serum creatinine and eGFR as the standard markers for CIN diagnosis, and compared them to both serum and urinary NGAL as well as serum CysC, assessed before and 4 hours after PCIP. Patients who developed CIN (16%) were older, with significantly higher discharge creatinine values, lower eGFR values at creatinine peak, and higher baseline and post-PCIP CysC values. We did not detect any significant association between baseline serum and urinary NGAL values and their 4 hour variations after contrast...
Diagnostic importance of cystatin C and creatinine for contrast-induced acute kidney injury
Vojnosanitetski pregled, 2019
Background/Aim. Contrast-induced acute kidney injury (CI-AKI) is a common complication after the percutaneous coronary intervention, associated with a prolonged hospital stay, increased medical costs, and risk of adverse clinical outcomes. The aim of this study was to compare changes in levels of serum creatinine (sCr) and cystatin C (sCyC) 24 h after coronary angiography as an early indicator of CI-AKI. Methods. The study included 45 patients with chronic renal failure grade I?III scheduled for coronary angiography. Levels of sCr and sCyC were measured a day before and 24 h after coronary angiography. CI-AKI was defined as a 25% and 10% increase of sCr and sCyC levels from baseline within 24 h from contrast media exposure, in the absence of alternative causes. Results. Mean sCr and sCyC concentra-tions were 86.4 ? 22.6 ?mol/L and 1.18 ? 0.52 mg/dL, respectively before contrast administration, and 90.6 ? 24.1 ?mol/L and 1.24 ? 0.65 mg/dL, respectively 24 h after contrast media expos...
Journal of the American Heart Association, 2017
Contrast-induced acute kidney injury (CI-AKI) was traditionally defined as an increase in serum creatinine (sCr) after contrast media exposure. Recently, serum cystatin C (sCyC) has been proposed as an alternative to detect acute changes in renal function. The clinical implications of combining sCyC and sCr to diagnose CI-AKI remain unknown. One thousand seventy-one consecutive patients undergoing coronary angiography/intervention were prospectively enrolled. SCyC and sCr were assessed at baseline and 24 to 48 hours after contrast media exposure. CI-AKI determined by sCr (CI-AKIsCr) was defined as an sCr increase greater than 0.3 mg/dL or 50% from baseline. Major adverse events at 12 months were assessed. CI-AKIsCr developed in 25 patients (2.3%). Twelve-month follow-up was available for 1063 patients; major adverse events occurred in 61 patients (5.7%). By receiver operating characteristic curve analysis, an sCyC increase of greater than 15% was the optimal cutoff for CI-AKIsCr det...
Cystatin C and Contrast-Induced Acute Kidney Injury
Circulation, 2010
Background-Cystatin C (CyC) is more sensitive than serum creatinine (sCr) to rapidly detect acute changes in renal function. Methods and Results-We measured CyC together with sCr in 410 consecutive patients with chronic kidney disease undergoing either coronary and/or peripheral angiography and/or angioplasty. sCr was assessed at baseline and 24 and 48 hours after contrast media exposure. CyC was assessed at baseline and at 24 hours. Major adverse events (including death of any cause and dialysis) at 12 months were assessed. At 48 hours after contrast media exposure, contrast-induced acute kidney injury (defined as a sCr increase Ն0.3 mg/dL) occurred in 34 patients (8.2%). A CyC increase concentration Ն10% at 24 hours after contrast media exposure was detected in 87 patients (21.2%). This was the best CyC cutoff for the early identification of patients at risk for contrast-induced acute kidney injury (negative predictive valueϭ100%; positive predictive valueϭ39.1%). According to the defined cutoffs (that is, increase in CyC Ն10% and sCr Ն0.3 mg/dL), major adverse events occurred in 16 of 297 patients (5.4%) without any cutoffs satisfied (group 1), in 9 of 49 patients (18.4%) with only a CyC increase Ն10% (group 2), and in 9 of 31 patients (29%) with both cutoffs satisfied (group 3). By logistic regression analysis, the independent predictors of major adverse events at 1 year were group 2 (odds ratioϭ2.52; 95% confidence interval, 1.17 to 5.41; Pϭ0.02), group 3 (odds ratioϭ4.45; 95% confidence interval, 1.72 to 11.54; Pϭ0.002), and baseline glomerular filtration rate (odds ratioϭ0.91; 95% confidence interval, 0.88 to 0.95; PϽ0.001). Conclusions-In patients with chronic kidney disease, CyC seems to be a reliable marker for the early diagnosis and prognosis of contrast-induced acute kidney injury. (Circulation. 2010;121:2117-2122.)
Biomarkers for Diagnosis and Prediction of Outcomes in Contrast-Induced Nephropathy
International Journal of Nephrology
Background. Serum creatinine is suboptimal as a biomarker in the early diagnosis of contrast-induced nephropathy (CIN). In this study, we investigated a panel of novel biomarkers in the early diagnosis of CIN and in assessing patient outcomes. Methods. This single-centre, nested, prospective case-controlled study included 30 patients with CIN and 60 matched controls. Serum and urine samples were collected before contrast administration and at 24 hours, 48 hours, and ≥5 days after contrast administration. Concentrations of NGAL, cystatin C, β2M, IL18, IL10, KIM1, and TNFα were determined using Luminex and ELISA assays. Outcomes were biomarker diagnostic discrimination performance for CIN and mortality after generation of area under receiver operating characteristic curves (AUROCs). Results. Median serum levels for 24 h cystatin C (p<0.01) and 48 h β2M levels (p<0.001) and baseline urine NGAL (p=0.02) were higher in CIN patients compared to controls with AUROCs of 0.75, 0.78, an...
Risk score of contrast-induced nephropathy in patients after percutaneous coronary intervention
2021
Risk score of contrast-induced nephropathy in patients after percutaneous coronary intervention Morlim Limbong1*, Yan Herry2, Pipin Ardhianto2, Suhartono3 Background: Contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) is still an issue in modern revascularization era. Recent risk stratification model used creatinine as biomarker which has some limitations. Increased ≥ 10 % of Cystatin-C after PCI has proven to be one of the earliest and accurate CIN after PCI biomarkers. The study aims to develop risk score based on predictors of contrast-induced nephropathy in patients after PCI with Cystatin-C as biomarker. Methods: A prospective cohort study of 129 patients after PCI at Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using bivariate chi-square test and multivariate logistic regression. The independent predictors obtained were then used as risk score variables. The Hosmer and Lemeshow calibration test and AUC ROC analysis fo...
Indian Heart Journal, 2017
We aimed to compare the diagnostic efficacy of serum cystatin C (sCyC) for contrast induced nephropathy (CIN) in Western Indians undergoing cardiac catheterization. We also aimed to propose a clinically applicable cutoff of sCyC for early identification of CIN in this ethnic group. Methods: In this prospective study, 253 patients undergoing coronary angiography and/or percutaneous coronary intervention were enrolled. The demographic and risk factor details, levels of sCr at baseline, 24 and 48 h after the procedure, whereas baseline and 24 h levels of sCyC were noted. Increase of 0.5 mg/dl or !25% from baseline sCr was used to define CIN. Optimum cut off of sCyC for CIN diagnosis was obtained using Receiver Operating Characteristic (ROC) curve analysis. Results: After 48 h of contrast media (CM) exposure, the incidence of CIN was 12.25% (31 patients) according to sCr definition, where only 3.9% (10 patients) had sCr rise in 24 h. Overall significant (p < 0.0001) rise in mean levels of sCr (48 h) and sCyC (24 h) was observed in CIN patients. However, the mean sCr rise at 24 h was non-significant. The optimum cut off of sCyC for diagnosing CIN was found to be a rise of !10% from baseline (AUC-0.901; sensitivity-100%, specificity-77.89%). According to sCyC, 94 (37.15%) patients had CIN. Conclusion: We may conclude that a rise of !10% in sCyC at 24 h could be used as a reliable marker for identification of CIN in western Indians undergoing cardiac catheterization.