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Preprocedural High-Sensitivity C-Reactive Protein Predicts Contrast-Induced Nephropathy and Long-Term Outcome After
Xiao-Sheng Guo1, Kai-Yang Lin1,2, Hua-Long Li1
11 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
High-sensitivity C-reactive protein (hsCRP) predicts contrast-induced nephropathy (CIN) after coronary angiography (CAG). Elevated hsCRP levels also indicate a higher risk of long-term mortality in these patients.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Contrast-induced nephropathy (CIN) is a significant complication following coronary angiography (CAG).
- Identifying reliable predictors of CIN and long-term outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the association between preprocedural high-sensitivity C-reactive protein (hsCRP) levels and the incidence of CIN.
- To evaluate the correlation of hsCRP with long-term mortality after CAG.
Main Methods:
- A cohort of 2133 patients undergoing CAG were enrolled, with preprocedural hsCRP measurements.
- Patients were followed for a median of 2.3 years to assess CIN incidence and mortality.
- Statistical analyses, including ROC analysis and adjusted regression models, were employed.
Main Results:
- The overall incidence of CIN was 2.77%.
- A significant positive trend was observed between increasing hsCRP quartiles and CIN rates (Q4 >11.3 mg/L had 6.8% incidence).
- An hsCRP cutoff of 7.3 mg/L demonstrated predictive value for CIN (AUC=0.742), comparable to the Mehran score, and remained an independent predictor (OR=2.83).
- Elevated hsCRP (>7.3 mg/L) was independently associated with increased long-term mortality (OR=2.04).
Conclusions:
- Preprocedural hsCRP is a valuable independent predictor of CIN following CAG.
- Elevated hsCRP levels are associated with increased long-term mortality in patients undergoing CAG.
- hsCRP may serve as a useful biomarker for risk stratification in patients undergoing coronary angiography.
Abstract:
We investigated whether high-sensitivity C-reactive protein (hsCRP) levels were associated with contrast-induced nephropathy (CIN) and long-term mortality after coronary angiography (CAG). Patients (N = 2133) undergoing CAG with preprocedural hsCRP were consecutively enrolled. High-sensitivity C-reactive protein was measured before angiography. Median follow-up was 2.3 years. The overall incidence of CIN was 2.77% (59 of 2133). There was a positive trend of hsCRP quartiles (Q) with rates of CIN: 0.9% for Q1 (<1.6 mg/L), 0.9% for Q2 (1.6-3.9 mg/L), 2.4% for Q3 (4.0-11.3mg/L), and 6.8% for Q4 (>11.3 mg/L; P < .05). The receiver operating characteristic (ROC) analysis showed that the cutoff point of hsCRP was 7.3 mg/L for predicting CIN with a 72.7% sensitivity and a 67.0% specificity (area under the curve [AUC] = 0.742, 95% confidence interval [CI] 0.672-0.810; P < .05). The predictive value of hsCRP was similar to the Mehran score for CIN (AUChsCRP = 0.742 vs AUCMehran = 0.801; P = .228). After adjustment for other potential risk factors, hsCRP >7.3 mg/L still was an independent predictor of CIN (odds ratio [OR] = 2.83, 95% CI: 1.44-5.58; P = .003). Furthermore, hsCRP >7.3 mg/L was associated with higher mortality (OR = 2.04, 95% CI: 1.30-3.19; P = .002).
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