Prognostic value of inflammatory biomarkers and GRACE score for cardiac death and acute kidney injury after acute coronary syndromes.

Rossi, Valentina A; Denegri, Andrea; Candreva, Alessandro; Klingenberg, Roland; Obeid, Slayman; Räber, Lorenz; Gencer, Baris; Mach, François; Nanchen, David; Rodondi, Nicolas; Heg, Dik; Windecker, Stephan; Buhmann, Joachim; Ruschitzka, Frank; Lüscher, Thomas F; Matter, Christian M (2021). Prognostic value of inflammatory biomarkers and GRACE score for cardiac death and acute kidney injury after acute coronary syndromes. European Heart Journal: Acute Cardiovascular Care, 10(4), pp. 445-452. Sage 10.1093/ehjacc/zuab003

[img] Text
Rossi__Eur_Heart_J_Acute_Cardiovasc_Care_2021.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (548kB) | Request a copy

AIMS

The aim of this study was to analyse the role of inflammation and established clinical scores in predicting acute kidney injury (AKI) after acute coronary syndromes (ACS).

METHODS AND RESULTS

In a prospective multicentre cohort including 2034 patients with ACS undergoing percutaneous coronary intervention, high-sensitivity C-reactive protein (hsCRP), neutrophil count, neutrophil-to-lymphocyte ratio (NL-ratio), and creatinine were measured at the index procedure. AKI (n = 39, defined according to RIFLE criteria) and major cardiovascular and cerebrovascular events were adjudicated after 1 year. Associations between inflammation, AKI, and cardiac death (CD) were assessed by C-statistics and Cox proportional hazard models with log-rank test to compare survival. Patients with ACS with elevated neutrophil count >7.8 × 109/L, NL-ratio >5, combined neutrophil-count/creatinine, or NL-ratio/creatinine at baseline showed a higher incidence of AKI (all P < 0.05) and CD (all P < 0.001). The risk of AKI, CD, and their combination was increased in patients with higher neutrophil count/creatinine (heart rate (HR) = 3.7, 95% cardiac index (CI) 1.9-7.1; HR = 2.7, 95% CI 1.6-4.6; HR = 3.2, 95% CI 2.1-4.9); NL-ratio/creatinine (HR = 2.1, 95% CI 1.6-4.1; HR = 2.2, 95% CI 1.3-3.8; HR = 2.3, 95% CI 1.5-3.5); and hsCRP (HR = 1.8, 95% CI 0.9-3.5; HR = 2.2, 95% CI 1.3-3.6; HR = 1.9, 95% CI 1.2-2.8) after adjustment for age, diabetes, hypertension, previous heart failure, kidney function, haemodynamic instability at admission, statin, and renin-angiotensin-aldosterone antagonists use. Subjects with higher GRACE score 1.0/NL-ratio had higher rate of AKI, CD, and both (HR = 1.4, 95% CI 0.5-4.2; HR = 2.7, 95% CI 1.3-5.9; HR = 2.1, 95% CI 1-4.3).

CONCLUSIONS

Inflammation markers may predict AKI after correction for renal function at the index procedure. hsCRP performed better than the NL-ratio. However, the integration of inflammation markers to traditional risk factors or scores does not add prognostic information.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01000701.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Räber, Lorenz; Rodondi, Nicolas; Heg, Dierik Hans and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2048-8734

Publisher:

Sage

Funders:

[4] Swiss National Science Foundation ; [116] Swiss Heart Foundation = Schweizerische Herzstiftung

Language:

English

Submitter:

Christine Baumgartner

Date Deposited:

15 Mar 2021 11:48

Last Modified:

28 May 2021 01:32

Publisher DOI:

10.1093/ehjacc/zuab003

PubMed ID:

33624028

Uncontrolled Keywords:

Acute kidney injury GRACE score Inflammation Neutrophil-to-lymphocyte ratio hsCRP  Acute coronary syndromes

BORIS DOI:

10.48350/152798

URI:

https://boris.unibe.ch/id/eprint/152798

Actions (login required)

Edit item Edit item
Provide Feedback