C-reactive protein velocity and the risk of acute kidney injury among ST elevation myocardial infarction patients undergoing primary percutaneous intervention

  • David Zahler
  • Keren-Lee Rozenfeld
  • Maya Stein
  • Assi Milwidsky
  • Shlomo Berliner
  • Shmuel Banai
  • Yaron Arbel
  • Yacov ShachamEmail author
Original Article



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.


C-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.

Ethical approval

The study protocol was approved by the local institutional ethics committee.


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Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  1. 1.Department of Cardiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael

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