Prediction of contrast induced acute kidney injury using novel biomarkers following contrast coronary angiography

QJM. 2018 Feb 1;111(2):103-110. doi: 10.1093/qjmed/hcx201.

Abstract

Background/introduction: Chronic kidney disease (CKD) is a risk factor for contrast induced acute kidney injury (CI-AKI). Contrast angiography in CKD patients is a common procedure. Creatinine is a delayed marker of CI-AKI and delays diagnosis which results in significant morbidity and mortality.

Aim: Early diagnosis of CI-AKI requires validated novel biomarkers.

Design: A prospective observation study of 301 consecutive CKD patients undergoing coronary angiography was performed.

Methods: Samples for plasma neutrophil gelatinase-associated lipocalin (NGAL), serum liver fatty acid-binding protein (L-FABP), serum kidney injury marker 1, serum interleukin 18 and serum creatinine were taken at 0, 1, 2, 4, 6 and 48 h post-contrast. Urinary NGAL and urinary cystatin C were collected at 0, 6 and 48 h. Incidence of major adverse clinical events (MACE) was recorded at 1 year. CI-AKI was defined as an absolute delta rise in creatinine of ≥26.5 µmol/l or a 50% relative rise from baseline at 48 h following contrast.

Results: CI-AKI occurred in 28 (9.3%) patients. Plasma NGAL was most predictive of CI-AKI at 6 h. L-FABP performed best at 4 h. A combination of Mehran score > 10, 4 h L-FABP and 6 h NGAL improved specificity to 96.7%. MACE was statistically higher at 1 year in CI-AKI patients (25.0 vs. 6.2% in non-CI-AKI patients).

Discussion/conclusion: Mehran risk score, 4 h serum L-FAPB and 6 h plasma NGAL performed best at early CI-AKI prediction. CI-AKI patients were four times more likely to develop MACE and had a trebling of mortality risk at 1 year.

Publication types

  • Observational Study

MeSH terms

  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / etiology
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Contrast Media / adverse effects*
  • Coronary Angiography / adverse effects*
  • Fatty Acid-Binding Proteins / blood
  • Female
  • Glomerular Filtration Rate / physiology
  • Humans
  • Lipocalin-2 / blood
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications
  • Risk Factors

Substances

  • Biomarkers
  • Contrast Media
  • Fatty Acid-Binding Proteins
  • LCN2 protein, human
  • Lipocalin-2