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Published on: May 28, 2019
Elevated high-sensitivity C-reactive protein combined with procalcitonin predicts high risk of contrast-induced
Guoqiang Gu1, Xuechao Yuan1, Yaqing Zhou1
1Department of Cardiology, Second Hospital of Hebei Medical University, No. 215 Hepingxi Road, Shijiazhuang, 050000, Hebei, China.
Insights
Combining high-sensitivity C-reactive protein (hs-CRP) and procalcitonin effectively predicts contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). This combined biomarker approach offers improved sensitivity and specificity over individual markers for identifying patients at risk of CIN.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Contrast-induced nephropathy (CIN) is a frequent complication following percutaneous coronary intervention (PCI), associated with poor patient outcomes.
- Existing biomarkers like high-sensitivity C-reactive protein (hs-CRP) and procalcitonin show promise in predicting CIN, but their combined diagnostic utility remains unexplored.
Purpose of the Study:
- To evaluate the predictive value of combining hs-CRP and procalcitonin for CIN development after PCI.
- To compare the diagnostic performance of combined hs-CRP and procalcitonin against individual markers for CIN prediction.
Main Methods:
- A prospective study enrolled 343 patients undergoing PCI in 2016.
- Patients received standard hydration and furosemide; CIN was defined by a significant rise in serum creatinine within 72 hours post-procedure.
- Serum levels of hs-CRP and procalcitonin were measured prior to PCI.
Main Results:
- Elevated hs-CRP and procalcitonin levels were associated with higher CIN rates.
- The combination of hs-CRP and procalcitonin demonstrated superior predictive performance (AUC=0.67) compared to either marker alone.
- Logistic regression identified acute myocardial infarction, and high hs-CRP and procalcitonin as significant risk factors for CIN.
Conclusions:
- Pre-PCI elevation of hs-CRP and procalcitonin are risk factors for CIN.
- The combined assessment of hs-CRP and procalcitonin offers enhanced prediction of CIN post-PCI compared to individual measurements.
Background:
Contrast-induced nephropathy (CIN) is common after percutaneous coronary intervention (PCI) and always leads to a poor prognosis. Compared with conventional detection methods, either high-sensitivity C-reactive protein (hs-CRP) or procalcitonin have higher sensitivity and specificity for predicting CIN, but their combination has not been explored. This prospective study investigated the value of hs-CRP combined with procalcitonin for predicting CIN after PCI.
Methods:
All patients undergoing PCI admitted to our hospital during the year 2016 were consecutively enrolled (n = 343). The patients received adequate hydration before PCI and 20 mg furosemide after the procedure. CIN was diagnosed by a 25% elevation in serum creatinine or ≥ 44.2 μmol/L (0.5 mg/dL) serum creatinine within 48 to 72 h after intravenous injection of contrast media.
Results:
Patients with high hs-CRP or procalcitonin had higher rates of CIN relative to those patients with low values. For predicting CIN, hs-CRP combined with procalcitonin showed an area under the receiver operating characteristic curve of 0.67, with optimal cut-off value 0.0643610, and the sensitivity and specificity were higher than hs-CRP or procalcitonin alone. The logistic regression analysis showed that high-risk factors of CIN were acute myocardial infarction and highly elevated hsCRP and procalcitonin.
Conclusions:
Prior to PCI, an elevation of the inflammatory biomarkers hsCRP and procalcitonin are a risk factor for postoperative CIN. This study suggests that the combination of hsCRP and procalcitonin is a better predictor of CIN after PCI then either hsCRP or procalcitonin alone.
Trial Registration Number:
ChiCTR-IOR-14005250. Date of registration 2014-09-24.
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