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Sex differences in the association between d-dimer and the incidence of acute kidney injury in patients admitted with ST-segment elevation myocardial infarction: a retrospective observational study

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Abstract

Identifying the predictors of acute kidney injury (AKI) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remains important. We aimed to investigate the predictive value of d-dimer levels for the incidence of AKI in such a population, with particular attention paid to sex differences. A total of 2668 patients with STEMI who underwent PPCI were retrospectively included in this study and divided into quartiles according to their plasma d-dimer levels upon admission (Q1: < 0.36; Q2: 0.36–0.67; Q3: 0.68–1.17; Q4: > 1.17 mg/L). The primary endpoint was the occurrence of AKI during hospitalization. AKI was observed in 503 (18.8%) patients. The mean age of the patients was 63.0 ± 13.2 years, 2155 (80.8%) of whom were men. Multivariate analysis indicated that higher d-dimer levels were associated with a significantly increased risk of AKI (Q4 vs. Q1: OR: 1.57; 95% CI 1.11–2.23; P = 0.011). However, the prognostic effect of d-dimer was only observed in male patients (Q4 vs. Q1: OR: 2.07; 95% CI 1.37–3.13; P < 0.001), not in female patients (Q4 vs. Q1: OR: 0.72; 95% CI 0.37–1.41; P = 0.342) (P for interaction = 0.003). We demonstrated a notable sex difference in the association between d-dimer level upon admission and AKI in a large STEMI patient sample. A higher d-dimer level was associated with an increased risk of AKI in male patients but not in female patients.

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Data availability

The datasets that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AKI:

Acute kidney injury

CI-AKI:

Contrast-induced acute kidney injury

STEMI:

ST-segment elevation myocardial infarction

PPCI:

Primary percutaneous coronary intervention

AMI:

Acute myocardial infarction

HF:

Heart failure

CCU:

Coronary care unit

CKD:

Chronic kidney disease

EGFR:

Estimated glomerular filtration rate

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

KDIGO:

Kidney Disease: Improving Global Outcomes

TC:

Total cholesterol

LDL-c:

Low-density lipoprotein cholesterol

IQR:

Interquartile range

SBP:

Systolic blood pressure

LVEF:

Left ventricular ejection fraction

ALT:

Alanine transaminase

CK:

Creatine kinase

OR:

Odds ratio

CI:

Confidence interval

References

  1. Giacoppo D, Madhavan MV, Baber U, Warren J, Bansilal S, Witzenbichler B, Dangas GD, Kirtane AJ, Xu K, Kornowski R, Brener SJ, Généreux P, Stone GW, Mehran R (2015) Impact of contrast-induced acute kidney injury after percutaneous coronary intervention on short- and long-term outcomes: pooled analysis from the HORIZONS-AMI and ACUITY trials. Circ Cardiovasc Interv 8(8):e002475

    Article  CAS  PubMed  Google Scholar 

  2. Silvain J, Nguyen LS, Spagnoli V, Kerneis M, Guedeney P, Vignolles N, Cosker K, Barthelemy O, Le Feuvre C, Helft G, Collet JP, Montalescot G (2018) Contrast-induced acute kidney injury and mortality in ST elevation myocardial infarction treated with primary percutaneous coronary intervention. Heart (British Cardiac Society) 104(9):767–772

    CAS  PubMed  Google Scholar 

  3. Weitz JI, Fredenburgh JC, Eikelboom JW (2017) A test in context: d-dimer. J Am Coll Cardiol 70(19):2411–2420

    Article  CAS  PubMed  Google Scholar 

  4. Kikkert WJ, Claessen BE, Stone GW, Mehran R, Witzenbichler B, Brodie BR, Wöhrle J, Witkowski A, Guagliumi G, Zmudka K, Henriques JP, Tijssen JG, Sanidas EA, Chantziara V, Xu K, Dangas GD (2014) D-dimer levels predict ischemic and hemorrhagic outcomes after acute myocardial infarction: a HORIZONS-AMI biomarker substudy. J Thromb Thrombolysis 37(2):155–164

    Article  CAS  PubMed  Google Scholar 

  5. Zhang X, Wang S, Liu J, Wang Y, Cai H, Wang D, Fang S, Yu B (2021) D-dimer and the incidence of heart failure and mortality after acute myocardial infarction. Heart (British Cardiac Society) 107(3):237–244

    CAS  PubMed  Google Scholar 

  6. Lowe GD, Yarnell JW, Rumley A, Bainton D, Sweetnam PM (2001) C-reactive protein, fibrin d-dimer, and incident ischemic heart disease in the Speedwell study: are inflammation and fibrin turnover linked in pathogenesis? Arterioscler Thromb Vasc Biol 21(4):603–610

    Article  CAS  PubMed  Google Scholar 

  7. Liu KL, Lee KT, Chang CH, Chen YC, Lin SM, Chu PH (2014) Elevated plasma thrombomodulin and angiopoietin-2 predict the development of acute kidney injury in patients with acute myocardial infarction. Critical care (London, England) 18(3):R100

    Article  PubMed  Google Scholar 

  8. Mielniczuk LM, Pfeffer MA, Lewis EF, Blazing MA, de Lemos JA, Mohanavelu S, Rouleau J, Fox K, Pedersen TR, Califf RM (2009) Acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome. Clin J Am Soc Nephrol: CJASN 4(11):1811–1817

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tran L, Pannier B, Lacolley P, Serrato T, Benetos A, London GM, Bézie Y, Regnault V (2021) A case-control study indicates that coagulation imbalance is associated with arteriosclerosis and markers of endothelial dysfunction in kidney failure. Kidney Int 99(5):1162–1172

    Article  CAS  PubMed  Google Scholar 

  10. Scrascia G, Rotunno C, Simone S, Montemurno E, Amorese L, De Palo M, Castellano G, Pertosa GB, Gesualdo L, Paparella D (2017) Acute kidney injury in high-risk cardiac surgery patients: roles of inflammation and coagulation. J Cardiovasc Med (Hagerstown) 18(5):359–365

    Article  PubMed  Google Scholar 

  11. Xu Z, Cheng B, Fu S, Liu X, Xie G, Li Z, Ji Y, Fu Q, Xu Z, Fang X (2019) Coagulative biomarkers on admission to the ICU predict acute kidney injury and mortality in patients with septic shock caused by intra-abdominal infection. Infection Drug Resist 12:2755–2764

    Article  CAS  Google Scholar 

  12. Cheng Y, Luo R, Wang X, Wang K, Zhang N, Zhang M, Wang Z, Dong L, Li J, Zeng R, Yao Y, Ge S, Xu G (2020) The incidence, risk factors, and prognosis of acute kidney injury in adult patients with coronavirus disease 2019. Clin J Am Soc Nephrol: CJASN 15(10):1394–1402

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Luo CC, Zhong YL, Qiao ZY, Li CN, Liu YM, Zheng J, Sun LZ, Ge YP, Zhu JM (2022) Development and validation of a nomogram for postoperative severe acute kidney injury in acute type A aortic dissection. J Geriatr Cardiol: JGC 19(10):734–742

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Park J, Kim SU, Choi HJ, Hong SH, Chae MS (2022) Predictive role of the D-dimer level in acute kidney injury in living donor liver transplantation: a retrospective observational cohort study. J Clin Med 11(2):450

  15. Lin KY, Chen HC, Jiang H, Wang SY, Chen HM, Wu ZY, Jiang F, Guo YS, Zhu PL (2020) Predictive value of admission D-dimer for contrast-induced acute kidney injury and poor outcomes after primary percutaneous coronary intervention. BMC Nephrol 21(1):90

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Luo E, Wang D, Liu B, Hou J, Yan G, Tang C (2020) The value of D-dimer level in predicting contrast-induced acute kidney injury in patients with acute ST-segment elevation myocardial infarction after PCI. Clin Appl Thromb/Hemost: Off J Int Acad Clin Appl Thromb/Hemost 26:1076029620944492

    Article  CAS  Google Scholar 

  17. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S (2012) Third universal definition of myocardial infarction. Circulation 126(16):2020–2035

    Article  PubMed  Google Scholar 

  18. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Article  PubMed  PubMed Central  Google Scholar 

  19. Khwaja A (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 120(4):c179-184

    Article  PubMed  Google Scholar 

  20. Chen B, Liu J, Li Y, He X, Zhou C, Chen Y, Zheng M (2022) Elevated D-dimer levels correlate with the development of hepatorenal syndrome and a poor outcome in patients with cirrhosis. Scand J Gastroenterol 57(12):1486–1493

  21. Zhang Y, Lan Y, Chen T, Chen Q, Guo Z, Jiang N (2022) Prediction of acute kidney injury for acute type A aortic dissection patients who underwent sun’s procedure by a perioperative nomogram. Cardiorenal Med 12(3):117–130

    Article  CAS  PubMed  Google Scholar 

  22. Kalaria VG, Zareba W, Moss AJ, Pancio G, Marder VJ, Morrissey JH, Weiss HJ, Sparks CE, Greenberg H, Dwyer E, Goldstein R, Watelet LF (2000) Gender-related differences in thrombogenic factors predicting recurrent cardiac events in patients after acute myocardial infarction. The THROMBO Investigators. Am J Cardiol 85(12):1401–1408

    Article  CAS  PubMed  Google Scholar 

  23. Li L, Wang W, Li T, Sun Y, Gao Y, Wang L, Yao HC (2021) Gender-related difference in D-dimer level predicts in-hospital heart failure after primary PCI for ST-segment elevation myocardial infarction. Dis Markers 2021:7641138

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wang P, Yao J, Xie Y, Luo M (2020) Gender-specific predictive markers of poor prognosis for patients with acute myocardial infarction during a 6-month follow-up. J Cardiovasc Transl Res 13(1):27–38

    Article  PubMed  Google Scholar 

  25. Tanaka R, Tsutsui H, Ohkita M, Takaoka M, Yukimura T, Matsumura Y (2013) Sex differences in ischemia/reperfusion-induced acute kidney injury are dependent on the renal sympathetic nervous system. Eur J Pharmacol 714(1–3):397–404

    Article  CAS  PubMed  Google Scholar 

  26. Hutchens MP, Dunlap J, Hurn PD, Jarnberg PO (2008) Renal ischemia: does sex matter? Anesth Analg 107(1):239–249

    Article  PubMed  Google Scholar 

  27. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal syndrome. J Am Coll Cardiol 52(19):1527–1539

    Article  PubMed  Google Scholar 

  28. Seeliger E, Sendeski M, Rihal CS, Persson PB (2012) Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J 33(16):2007–2015

    Article  PubMed  Google Scholar 

  29. Shacham Y, Steinvil A, Arbel Y (2016) Acute kidney injury among ST elevation myocardial infarction patients treated by primary percutaneous coronary intervention: a multifactorial entity. J Nephrol 29(2):169–174

    Article  PubMed  Google Scholar 

  30. Erkol A, Oduncu V, Turan B, Kılıçgedik A, Sırma D, Gözübüyük G, Karabay CY, Guler A, Dündar C, Tigen K, Pala S, Kırma C (2014) The value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention and long-term prognosis in patients with acute ST segment elevation myocardial infarction. J Thromb Thrombolysis 38(3):339–347

    Article  CAS  PubMed  Google Scholar 

  31. Gong X, Lei X, Huang Z, Song Y, Wang Q, Qian J, Ge J (2021) D-dimer level predicts angiographic no-reflow phenomenon after percutaneous coronary intervention within 2–7 days of symptom onset in patients with ST-segment elevation myocardial infarction. J Cardiovasc Transl Res 14(4):728–734

    Article  PubMed  Google Scholar 

  32. Choi S, Jang WJ, Song YB, Lima JA, Guallar E, Choe YH, Hwang JK, Kim EK, Yang JH, Hahn JY, Choi SH, Lee SC, Lee SH, Gwon HC (2016) D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study. PLoS ONE 11(8):e0160955

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hansen CH, Ritschel V, Halvorsen S, Andersen G, Bjørnerheim R, Eritsland J, Arnesen H, Seljeflot I (2015) Markers of thrombin generation are associated with myocardial necrosis and left ventricular impairment in patients with ST-elevation myocardial infarction. Thromb J 13:31

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Caspi O, Habib M, Cohen Y, Kerner A, Roguin A, Abergel E, Boulos M, Kapeliovich MR, Beyar R, Nikolsky E, Aronson D (2017) Acute kidney injury after primary angioplasty: is contrast-induced nephropathy the culprit? J Am Heart Assoc 6(6):e005715

  35. Levi M, Ten Cate H (1999) Disseminated intravascular coagulation. N Engl J Med 341(8):586–592

    Article  CAS  PubMed  Google Scholar 

  36. Bisoendial RJ, Kastelein JJ, Levels JH, Zwaginga JJ, van den Bogaard B, Reitsma PH, Meijers JC, Hartman D, Levi M, Stroes ES (2005) Activation of inflammation and coagulation after infusion of C-reactive protein in humans. Circ Res 96(7):714–716

    Article  CAS  PubMed  Google Scholar 

  37. Shebuski RJ, Kilgore KS (2002) Role of inflammatory mediators in thrombogenesis. J Pharmacol Exp Ther 300(3):729–735

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the Wenzhou Science and Technology Program (2022Y0845).

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Author notes

  1. Xi Zhou and Dingzhou Wang are co-first authors.

Authors and Affiliations

  1. Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Xi Zhou

  2. Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Wenzhou, China

    Dingzhou Wang, Youkai Jin, Mengge Gong, Qingcheng Lin, Yanlei He, Weijian Huang, Peiren Shan & Dongjie Liang

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Contributions

XZ: conceived, designed, and drafted the manuscript; DZW: drafted the manuscript; YKJ and MGG: data collection, analysis, and interpretation; QCL: data analysis and interpretation; YLH: collected data and prepared figures; WJH and PRS: revised the manuscript critically for important intellectual content; DJL: conception and design, revising the manuscript critically for important intellectual content, and final approval of the manuscript submitted.

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Correspondence to Peiren Shan or Dongjie Liang.

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Zhou, X., Wang, D., Jin, Y. et al. Sex differences in the association between d-dimer and the incidence of acute kidney injury in patients admitted with ST-segment elevation myocardial infarction: a retrospective observational study. Intern Emerg Med 19, 91–98 (2024). https://doi.org/10.1007/s11739-023-03443-0

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