The Role of Endothelial Activation and Stress Index (EASIX) for Predicting Contrast-Induced Nephropathy and
Kurtulus Karauzum1, Veysel Ozan Tanık2, Alperen Tas2
1Cardiology Department, Kocaeli University Hospital, 41200 İzmit, Türkiye.
Insights
The endothelial activation and stress index (EASIX) can predict contrast-induced nephropathy (CIN) and in-hospital mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Higher EASIX scores indicate increased risk for these adverse outcomes.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- The endothelial activation and stress index (EASIX) is a composite biomarker for endothelial dysfunction and systemic stress.
- EASIX has shown predictive value for outcomes in hematologic malignancies.
Purpose of the Study:
- To evaluate the predictive capability of EASIX for contrast-induced nephropathy (CIN).
- To assess EASIX's role in predicting in-hospital mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
Main Methods:
- Retrospective analysis of 1552 STEMI patients who underwent primary PCI.
- Comparison of baseline characteristics between patients with and without CIN.
- Logistic regression and ROC curve analysis to identify predictors and optimal EASIX cut-offs.
Main Results:
- CIN developed in 7.6% of patients, associated with significantly higher EASIX scores.
- Independent predictors of CIN included age, chronic kidney disease (CKD), reduced left ventricular ejection fraction (LVEF), and EASIX (OR 2.467).
- EASIX also independently predicted in-hospital mortality (OR 3.592).
Conclusions:
- EASIX is a valuable indicator for predicting CIN development in STEMI patients undergoing primary PCI.
- EASIX effectively predicts in-hospital mortality in this patient cohort.
- The EASIX score integrates renal function, endothelial activation, and systemic stress markers for improved risk assessment.
Abstract:
Background: The endothelial activation and stress index (EASIX), derived from the serum lactate dehydrogenase, creatinine, and platelet counts, is a composite biomarker for endothelial dysfunction and systemic stress. It has been developed to predict clinical outcomes in hematologic malignancies. This study aimed to investigate the EASIX's predictive role in contrast-induced nephropathy (CIN) and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 1552 patients with STEMI who underwent primary PCI were retrospectively included. The patients were divided into two groups: CIN (+) and CIN (-). Baseline demographic, laboratory, clinic, and procedural variables were compared between the two groups. Logistic regression analysis was performed to identify independent predictors of CIN and in-hospital mortality, while receiver operating characteristic (ROC) curves were used to determine the optimal EASIX cut-off values. Results: CIN developed in 7.6% (n = 118) of the study population, and these patients had significantly increased EASIX scores. Those with CIN were older and exhibited higher rates of diabetes mellitus, chronic kidney disease (CKD), and decreased left ventricular ejection fraction (LVEF) (all p < 0.001). In multivariable analysis, age (OR 1.053), CKD (OR 1.338), reduced LVEF (OR 0.965), and EASIX (OR 2.467) independently predicted CIN. EASIX > 0.93 demonstrated strong discriminatory ability (AUC 0.785; sensitivity 72% and specificity 72%). EASIX also independently predicted in-hospital mortality (OR 3.592), with an optimal cut-off > 0.88 (AUC 0.774). Conclusions: By integrating markers of renal function, endothelial activation, and systemic stress, EASIX may serve as a useful and reliable indicator for predicting CIN development and in-hospital mortality in STEMI patients undergoing primary PCI.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes