Abstract 18402: Multi-Biomarker Approach for the Prediction of Acute Kidney Injury and Short-Term Clinical Outcome in Patients Undergoing Coronary Angiography
Objectives: We investigated the predictive value of neutrophil gelatinase associated lipocalin (NGAL), cystatin C (CysC) and human brain natriuretic peptide precursor (proBNP) for the early recognition of acute kidney injury (AKI).
Methods: One hundred and eight consecutive patients (pts) submitted to coronary angiography or elective percutaneous coronary intervention were prospectively enrolled. Blood samples were collected before (baseline), and 2, 24 and 48 hours (h), after contrast administration. NGAL, CysC and ProBNP levels at baseline and 2 h after contrast administration as well as their relative percent change between baseline and 2 h (% Δ) were put in a multivariate cox regression model to identify the best independent predictor for AKI. AKI was defined according to changes in creatinine and/or urine output (AKIN criteria). Two clinical risk scores (Mehran and Cigarroa) were implemented to assess the probability for AKI. Clinical follow up data were available for all the pts during the first 6 months after catheterization.
Results: Pts with AKI (n= 11) had higher Mehran score (12±01 vs 8±0.5, p=0.02) but similar Cigarroa score (13.5±1.5 vs 13±0.7, p=0.4) as compared to those without AKI. Similarly, pts with AKI had higher baseline CysC (1.9±0.16 vs 1.5±0.06 mg/mL, p=0.01) and ProBNP levels (4102±1607 vs 2107±532 pg/mL, p=0.02) and higher % Δ NGAL (21±16vs 2.1±1.9 %, p=0.01). By multivariate analysis, % Δ NGAL and baseline CysC levels were independent predictors of AKI (table). A multibiomarker approach combining all biomarkers analyzed did not add any significant prognostic value. Survivors at 6 months had lower NGAL 2h values as compared with non-survivors (81±44 vs 138±104, p=0.05).
Conclusions: Cystatin C levels before contrast administration as well as % Δ NGAL 2 h after contrast administration, reliably predict acute kidney injury in pts undergoing diagnostic coronary angiography or elective percutaneous coronary intervention.
- © 2010 by American Heart Association, Inc.