Pre-Procedural N-Terminal Pro-B Type Natriuretic Peptide Predicts Contrast-Induced Acute Kidney Injury and Long-Term Outcome in Elderly Patients After Elective Percutaneous Coronary Intervention
Pre-Procedural N-Terminal Pro-B Type Natriuretic Peptide Predicts Contrast-Induced Acute Kidney Injury and Long-Term Outcome in Elderly Patients After Elective Percutaneous Coronary Intervention
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DOI：
10.1536/ihj.17-573
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发表时间：
2018-09-01
影响因子：
1.5
通讯作者：
Zhu, Peng-li
中科院分区：
文献类型：
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作者：
Lin, Kai-yang;Wu, Zhi-yong;Zhu, Peng-li
该研究的目的是评估手术前n端前b型利钠肽（NT-proBNP）与造造剂诱导的急性肾损伤（CI-AKI）和择期经皮冠状动脉介入治疗（PCI）的老年患者的长期预后的关系。在2012年1月至2015年12月期间接受选择性PCI的540例75岁患者被纳入本研究。入院前测量NT-proBNP水平。CI-AKI定义为血清肌酐（SCr）相对升高bb0 = 50%。或在造影剂暴露后48小时内出现>= 0.3 mg/dL的绝对升高。采用受试者工作特征（ROC）和多变量logistic回归分析评估NT-proBNP对CIAM的预测价值。54例（10.0%）患者发生CI-AKI。根据ROC分析，NT-pro-BNP检测CI-AKI的最佳临界值为1133 pg/mL，敏感性66.7%，特异性70.8% （C统计值= 0.719;95% CL = 0.679-0.756）。多变量分析显示，ln - nt - probnp与CI- aki显著相关(优势比[OR] = 3.892; 95% CI。1.996 - -7.590;P < 0.001)。Cox回归分析显示，随访期间Lg- NT-proBNP与长期死亡率相关（校正风险比[HR] = 2.158; 95% CI, 1.246 ~ 3.740; P = 0.006）。术前NT-proBNP是选择性PCI后老年患者CI-AKI和长期死亡率的重要独立预测因子，预测CI-AKI的最佳截止点为1133 pg/mL。
The aim of the study is to evaluate the association of pre-procedural N-terminal pro-B type natriuretic peptide (NT-proBNP) with contrast-induced acute kidney injury (CI-AKI) and long-term outcomes in elderly patients undergoing elective percutaneous coronary intervention (PCI).A total of 540 patients aged 75 years who had undergone elective PCI between January 2012 and December 2015 were enrolled in this study. Admission NT-proBNP levels were measured before PCI. CI-AKI was defined as a relative increase in serum creatinine (SCr) of >= 50%. or an absolute increase of >= 0.3 mg/dL, occurring within 48 hours after contrast medium exposure. The predictive value of NT-proBNP for predicting CIAM was assessed by receiver operating characteristic (ROC) and multivariable logistic regression analysis.A total of 54 (10.0%) patients developed CI-AKI. The best cutoff value of NT-pro-BNP for detecting CI-AKI was 1133 pg/mL with 66.7% sensitivity and 70.8% specificity according to the ROC analysis (C statistic = 0.719; 95% CL 0.679-0.756). Multivariable analysis demonstrated that Lg-NT-proBNP is significantly related to CI-AKI (odds ratio [OR] = 3.892; 95% CI. 1.996-7.590; P < 0.001). Cox regression analysis showed that Lg- NT-proBNP is associated with long-term mortality (adjusted hazard ratio [HR] = 2.158; 95% CI, 1.246-3.740; P = 0.006) during follow-up.Pre-procedural NT-proBNP is a significant and independent predictor of CI-AKI and long-term mortality in elderly patients following elective PCI, and the best cutoff point for predicting CI-AKI was 1133 pg/mL.