The diagnostic value of the ratio of contrast medium volume to estimated glomerular filtration rate in contrast-induced nephropathy diabetics patients

doi:10.3877/cma.j.issn.2095-655X.2014.04.009

Abstract

Abstract:

Objective

To investigate the incidence of contrast-induced nephropathy(CIN) in patients undergoing percutaneous coronary intervention(PCI) and assess the predictive role of the ratio of contrast medium volume to estimated glomerular filtration rate (CMV/eGFR) in super-elderly diabetic patients undergoing elective PCI who developed CIN.

Methods

Eight hundred and seventy-five PCI patients were retrospectively collected in Affiliated Hospital of Jining Medical University.Patients were divided into CIN group and non-CIN group based on the presence of CIN.Date of the two groups were compared concerning sex, age, smoking, hypotension, LVEF, hemoglobin, LDL-C, glucose, history of hypertension and type 2 diabetes, serum creatinine and eGFR pre-PCI, serum creatinine and eGFR post 48 h-PCI.Risk factors for CIN were analyzed by logistic regression statistical model.

Results

Among eight hundred and seventy-five patients, forty-two patients experienced CIN (4.8%). The disease incidence of male, hypertention, type 2 diabetes, hyperlipidemia, smoking, hypotentino, anemia, myocardial infarction with shock was 65.71%, 54.86%, 37.26%, 22.51%, 34.17%, 16.80%, 4.20%, 8.91%, respectively.In the other two groups, the patients with the super-elderly (age≥70y) (33.33%, 19.33%, χ²=4.902, P<0.05), type 2 diabetes(52.38%, 36.49%, χ²=4.317, P=0.05), smoking(50.00%, 33.37%, χ²=4.914, P<0.05), with hypotention(28.57%, 16.21%, χ²=4.374, P<0.05), myocardial infarction combined with shock(19.05%, 8.40%, χ²=5.579, P<0.05), LVEF[(36.46±9.27)%, (43.62±3.46)%, t=2.398, P<0.05], and larger contrast medium volume[(154.5±95.3)mL, (115.04±49.63)mL, t=2.069, P<0.05] were proned to CIN.eGFR was lower in CIN[(72.50±15.06)ml/(min·1.73m²), (108.55±21.7)ml/(min·1.73m²), t=7.220, P<0.05]. There were significant differences between the two group in CMV/eGFR[(2.19±1.30), (1.01±0.40), t=-3.439, P<0.05]. Logistic regression analysis showed that age ≥70y(RR=5.27, P<0.05), type 2 diabetes(RR=9.87, P<0.05), LVEF(RR=7.35, P<0.05), pre-PCI eGFR(RR=4.12, P<0.05), myocardial infarction with shock(RR=6.75, P<0.05), CMV/eGFR(RR=13.45, P<0.05)were the risk factors for CIN. ROC analysis indicated that a CMV/eGFR of more than 1.5 was a predictor of CIN.The sensitivity and specificity for CIN of CMV/eGFR of more than 1.5 was 72.50% and 84.00%, respectively.

Conclusions

It is very important to estimate risk factors of patients before PCI.The super-elderly diabetic patients are proned to CIN.The CMV/eGFR ratio could be a valuable predictor for CIN in super-elderly diabetic patients after elective PCI.

Key words: Percutaneous coronary intervention, Contrast-induced nephropathy, Contrast medium volume, Estimated glomerular filtration rate, Super-elderly, Diabetes

Lei Liu, Li Shi, Yiming Zhang, Yanfu Wang, Xinjian Li, Qingxian Li. The diagnostic value of the ratio of contrast medium volume to estimated glomerular filtration rate in contrast-induced nephropathy diabetics patients[J]. Chinese Journal of Diagnostics(Electronic Edition), 2014, 02(04): 279-284.

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References 28

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组别	例数	性别(例，男/女)	年龄(岁，±s)	低血压症(例，%)	高血压病(例，%)	高脂血症(例，%)	糖尿病(例，%)	吸烟(例，%)	高龄(例，%)
CIN组	42	32/10	64.2±11.4	12(28.57)	24(57.14)	12(28.57)	22(52.38)	21(50.00)	14(33.33)
非CIN组	833	543/190	60.7± 9.3	135(16.21)	456(54.74)	185(22.21)	304(36.49)	278(33.37)	161(19.33)
统计量	?	χ²＝0.314	t＝2.050	χ²＝4.374	χ²＝0.093	χ²＝0.928	χ²＝4.317	χ²＝4.914	χ²＝4.902
P值	?	0.575	0.042	0.037	0.760	0.335	0.038	0.036	0.027
组别	例数	心肌梗死伴休克(例，%)	血红蛋白(g/L，±s)	射血分数(%，±s)	血肌酐(μmol/L，±s)	eGFR [ml/(min·1.73m²)，±s]	CMV (mL，±s)	CMV/eGFR (±s)
CIN组	42	8(19.05)	120.49±9.46	36.46±9.27	82.46±20.38	72.50±15.06	154.50±95.30	2.19±1.30
非CIN组	833	70(8.40)	128.69±7.64	43.62±3.46	69.01±28.92	108.55±21.70	115.04±49.63	1.01±0.40
统计量	?	χ²＝5.579	t＝0.422	t＝2.398	t＝2.030	t＝7.220	t＝2.069	t＝－3.439
P值	?	0.018	0.660	0.026	0.080	0.026	0.046	0.006

组别	例数	性别(例，男/女)	年龄(岁，±s)	低血压症(例，%)	高血压病(例，%)	高脂血症(例，%)	糖尿病(例，%)	吸烟(例，%)	高龄(例，%)
CIN组	42	32/10	64.2±11.4	12(28.57)	24(57.14)	12(28.57)	22(52.38)	21(50.00)	14(33.33)
非CIN组	833	543/190	60.7± 9.3	135(16.21)	456(54.74)	185(22.21)	304(36.49)	278(33.37)	161(19.33)
统计量	?	χ²＝0.314	t＝2.050	χ²＝4.374	χ²＝0.093	χ²＝0.928	χ²＝4.317	χ²＝4.914	χ²＝4.902
P值	?	0.575	0.042	0.037	0.760	0.335	0.038	0.036	0.027
组别	例数	心肌梗死伴休克(例，%)	血红蛋白(g/L，±s)	射血分数(%，±s)	血肌酐(μmol/L，±s)	eGFR [ml/(min·1.73m²)，±s]	CMV (mL，±s)	CMV/eGFR (±s)
CIN组	42	8(19.05)	120.49±9.46	36.46±9.27	82.46±20.38	72.50±15.06	154.50±95.30	2.19±1.30
非CIN组	833	70(8.40)	128.69±7.64	43.62±3.46	69.01±28.92	108.55±21.70	115.04±49.63	1.01±0.40
统计量	?	χ²＝5.579	t＝0.422	t＝2.398	t＝2.030	t＝7.220	t＝2.069	t＝－3.439
P值	?	0.018	0.660	0.026	0.080	0.026	0.046	0.006

参数	RR值	95%CI	P值
年龄≥70岁	5.27	1.57～22.91	0.022
糖尿病	9.87	1.54～10.80	0.002
射血分数	7.35	1.23～12.02	0.007
术前eGFR	4.12	1.02～6.94	0.043
心肌梗死合并休克	6.75	2.48～21.07	0.009
CMV/eGFR	13.45	1.08～2.13	0.000

参数	RR值	95%CI	P值
年龄≥70岁	5.27	1.57～22.91	0.022
糖尿病	9.87	1.54～10.80	0.002
射血分数	7.35	1.23～12.02	0.007
术前eGFR	4.12	1.02～6.94	0.043
心肌梗死合并休克	6.75	2.48～21.07	0.009
CMV/eGFR	13.45	1.08～2.13	0.000

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