C-reactive protein velocity and the risk of acute kidney injury among ST elevation myocardial infarction patients undergoing primary percutaneous intervention
- 18 Downloads
Elevated C-reactive protein (CRP) was shown to be associated with an increased risk for acute kidney injury (AKI) in ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), however, the optimal time frame to measure CRP for risk stratification is not known. We evaluated the relation between the change in CRP over time (CRP velocity-CRPv) and AKI among STEMI patients treated with primary PCI.
We included 801 STEMI who presented between 2007 and 2017 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in h) between the two measurements. Patient’s medical records were reviewed for occurrence of AKI.
Mean age was 62 ± 16 and 80% were males. Patients with AKI had significantly higher CRPv (1.47 versus 0.4 mg/l/h, p < 0.001). In a multivariate regression model CRPv was independently associated with AKI (OR 1.03, 95% CI 1.01–1.0 5, p = 0.001). On receiver operating characteristic (ROC) curve the optimal cutoff value of CRPv to predict AKI was measured as more than 0.8 mg/l/h, with 70% sensitivity and 65% specificity (AUC 0.712, 95% CI 0.64–0.78, p < 0.001).
CRPv might be an independent and rapidly measurable biomarker for AKI following primary PCI in STEMI patients.
KeywordsC-reactive protein Acute kidney injury Acute myocardial infarction Biomarkers
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study protocol was approved by the local institutional ethics committee.
- 2.Suleiman M, Khatib R, Agmon Y, Mahamid R, Boulos M, Kapeliovich M, Levy Y, Beyar R, Markiewicz W, Hammerman H, Aronson D (2006) Early inflammation and risk of long-term development of heart failure and mortality in survivors of acute myocardial infarction predictive role of C-reactive protein. J Am Coll Cardiol 47(5):962–968. https://doi.org/10.1016/j.jacc.2005.10.055 CrossRefGoogle Scholar
- 3.Shacham Y, Leshem-Rubinow E, Ben Assa E, Rogowski O, Topilsky Y, Roth A, Steinvil A (2013) Comparison of C-reactive protein and fibrinogen levels in patients having anterior wall ST-Segment elevation myocardial infarction with versus without left ventricular thrombus (from a primary percutaneous coronary intervention cohort). Am J Cardiol 112(1):57–60. https://doi.org/10.1016/j.amjcard.2013.02.052 CrossRefGoogle Scholar
- 4.Margolis G, Gal-Oz A, Letourneau-Shesaf S, Khoury S, Keren G, Shacham Y (2018) Acute kidney injury based on the KDIGO criteria among ST elevation myocardial infarction patients treated by primary percutaneous intervention. J Nephrol 31(3):428–428. https://doi.org/10.1007/s40620-017-0461-3 CrossRefGoogle Scholar
- 5.Fertin M, Hennache B, Hamon M, Ennezat PV, Biausque F, Elkohen M, Nugue O, Tricot O, Lamblin N, Pinet F, Bauters C (2010) Usefulness of serial assessment of B-type natriuretic peptide, troponin I, and C-reactive protein to predict left ventricular remodeling after acute myocardial infarction (from the REVE-2 study). Am J Cardiol 106(10):1410–1416. https://doi.org/10.1016/j.amjcard.2010.06.071 CrossRefGoogle Scholar
- 6.Orn S, Manhenke C, Ueland T, Damas JK, Mollnes TE, Edvardsen T, Aukrust P, Dickstein K (2009) C-reactive protein, infarct size, microvascular obstruction, and left-ventricular remodelling following acute myocardial infarction. Eur Heart J 30(10):1180–1186. https://doi.org/10.1093/eurheartj/ehp070 CrossRefGoogle Scholar
- 8.Shacham Y, Leshem-Rubinow E, Steinvil A, Keren G, Roth A, Arbel Y (2015) High sensitive C-reactive protein and the risk of acute kidney injury among ST elevation myocardial infarction patients undergoing primary percutaneous intervention. Clin Exp Nephrol 19(5):838–843. https://doi.org/10.1007/s10157-014-1071-1 CrossRefGoogle Scholar
- 12.American College of Emergency Society for Cardiovascular P, Interventions A, O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 61 (4):e78–e140. https://doi.org/10.1016/j.jacc.2012.11.019 CrossRefGoogle Scholar
- 13.Arbel Y, Eros Y, Rogowski O, Berliner S, Shapira I, Keren G, Vered Y, Banai S (2007) Comparison of values of wide-range C-reactive protein to high-sensitivity C-reactive protein in patients undergoing coronary angiography. Am J Cardio 99(11):1504–1506. https://doi.org/10.1016/j.amjcard.2007.01.020 CrossRefGoogle Scholar
- 16.Vrsalovic M, Pintaric H, Babic Z, Pavlov M, Vrsalovic Presecki A, Getaldic B, Vrkic N, Nikolic Heitzler V (2012) Impact of admission anemia, C-reactive protein and mean platelet volume on short term mortality in patients with acute ST-elevation myocardial infarction treated with primary angioplasty. Clin Biochem 45(16–17):1506–1509. https://doi.org/10.1016/j.clinbiochem.2012.05.026 CrossRefGoogle Scholar
- 17.Registry MKMI, Meisinger C, Heier M, von Scheidt W, Kuch B (2010) Admission C-reactive protein and short-as well as long-term mortality in diabetic versus non-diabetic patients with incident myocardial infarction. Clin Res Cardiol 99(12):817–823. https://doi.org/10.1007/s00392-010-0193-z CrossRefGoogle Scholar
- 18.Kuch B, von Scheidt W, Kling B, Heier M, Hoermann A, Meisinger C (2008) Differential impact of admission C-reactive protein levels on 28-day mortality risk in patients with ST-elevation versus non-ST-elevation myocardial infarction (from the Monitoring Trends and Determinants on Cardiovascular Diseases [MONICA]/Cooperative Health Research in the Region of Augsburg [KORA] Augsburg Myocardial Infarction Registry). Am J Cardiol 102(9):1125–1130. https://doi.org/10.1016/j.amjcard.2008.06.034 CrossRefGoogle Scholar
- 19.Cermak J, Key NS, Bach RR, Balla J, Jacob HS, Vercellotti GM (1993) C-reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood 82(2):513–520Google Scholar
- 20.Fujii H, Li SH, Szmitko PE, Fedak PW, Verma S (2006) C-reactive protein alters antioxidant defenses and promotes apoptosis in endothelial progenitor cells. Arterioscler Thromb Vasc Biol 26(11):2476–2482. https://doi.org/10.1161/01.ATV.0000242794.65541.02 CrossRefGoogle Scholar
- 21.Russo D, Minutolo R, Cianciaruso B, Memoli B, Conte G, De Nicola L (1995) Early effects of contrast media on renal hemodynamics and tubular function in chronic renal failure. J Am Soc Nephrol 6(5):1451–1458Google Scholar
- 23.Xinwei J, Xianghua F, Jing Z, Xinshun G, Ling X, Weize F, Guozhen H, Yunfa J, Weili W, Shiqiang L (2009) Comparison of usefulness of simvastatin 20 mg versus 80 mg in preventing contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Am J Cardiol 104(4):519–524. https://doi.org/10.1016/j.amjcard.2009.04.014 CrossRefGoogle Scholar
- 24.Mager A, Vaknin Assa H, Lev EI, Bental T, Assali A, Kornowski R (2011) The ratio of contrast volume to glomerular filtration rate predicts outcomes after percutaneous coronary intervention for ST-segment elevation acute myocardial infarction. Catheter Cardiovasc Interv 78:198–201CrossRefGoogle Scholar
- 25.Marenzi G, De Metrio M, Rubino M, Lauri G, Cavallero A, Assanelli E, Grazi M, Moltrasio M, Marana I, Campodonico J, Discacciati A, Veglia F, Bartorelli AL (2010) Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention. Am Heart J 160:1170–1177CrossRefGoogle Scholar