Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications
BackgroundContrast‐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 comb...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.116.004747 |
| _version_ | 1818289564919267328 |
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| author | Wei‐feng Zhang Tuo Zhang Ding Ding Shi‐qun Sun Xiao‐lei Wang Shi‐chun Chu Ling‐hong Shen Ben He |
| author_facet | Wei‐feng Zhang Tuo Zhang Ding Ding Shi‐qun Sun Xiao‐lei Wang Shi‐chun Chu Ling‐hong Shen Ben He |
| author_sort | Wei‐feng Zhang |
| collection | DOAJ |
| description | BackgroundContrast‐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. Methods and ResultsOne 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 detection, which occurred in 187 patients (17.4%). To evaluate the use of both sCyC and sCr as CI‐AKI diagnostic criteria, we stratified patients into 3 groups: no CI‐AKI, CI‐AKI detected by a single marker, and CI‐AKI detected by both markers. Multivariable logistic regression revealed that the predictability of major adverse events increased in a stepwise fashion in the 3 groups (no‐CI‐AKI group as the reference, CI‐AKI detected by a single marker: odds ratio=2.25, 95% CI: 1.24–4.10, P<0.01; CI‐AKI detected by both markers: odds ratio=10.00, 95% CI: 3.13–31.91, P<0.001). ConclusionsCombining sCyC and sCr to diagnose CI‐AKI would be beneficial for risk stratification and prognosis in patients after contrast media exposure. |
| first_indexed | 2024-12-13T02:14:17Z |
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| id | doaj.art-27966419c4664f74ad0acf415b62a5f7 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T02:14:17Z |
| publishDate | 2017-01-01 |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-27966419c4664f74ad0acf415b62a5f72022-12-22T00:02:56ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-01-016110.1161/JAHA.116.004747Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical ImplicationsWei‐feng Zhang0Tuo Zhang1Ding Ding2Shi‐qun Sun3Xiao‐lei Wang4Shi‐chun Chu5Ling‐hong Shen6Ben He7Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Biostatistics, Johns Hopkins University, Baltimore, MDDepartment of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaBackgroundContrast‐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. Methods and ResultsOne 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 detection, which occurred in 187 patients (17.4%). To evaluate the use of both sCyC and sCr as CI‐AKI diagnostic criteria, we stratified patients into 3 groups: no CI‐AKI, CI‐AKI detected by a single marker, and CI‐AKI detected by both markers. Multivariable logistic regression revealed that the predictability of major adverse events increased in a stepwise fashion in the 3 groups (no‐CI‐AKI group as the reference, CI‐AKI detected by a single marker: odds ratio=2.25, 95% CI: 1.24–4.10, P<0.01; CI‐AKI detected by both markers: odds ratio=10.00, 95% CI: 3.13–31.91, P<0.001). ConclusionsCombining sCyC and sCr to diagnose CI‐AKI would be beneficial for risk stratification and prognosis in patients after contrast media exposure.https://www.ahajournals.org/doi/10.1161/JAHA.116.004747contrast‐induced acute kidney injurydiagnosisprognosisrisk stratification |
| spellingShingle | Wei‐feng Zhang Tuo Zhang Ding Ding Shi‐qun Sun Xiao‐lei Wang Shi‐chun Chu Ling‐hong Shen Ben He Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease contrast‐induced acute kidney injury diagnosis prognosis risk stratification |
| title | Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications |
| title_full | Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications |
| title_fullStr | Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications |
| title_full_unstemmed | Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications |
| title_short | Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast‐Induced Acute Kidney Injury and Its Clinical Implications |
| title_sort | use of both serum cystatin c and creatinine as diagnostic criteria for contrast induced acute kidney injury and its clinical implications |
| topic | contrast‐induced acute kidney injury diagnosis prognosis risk stratification |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.116.004747 |
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