A High Preoperative Neutrophil Percentage-to-Albumin Ratio Is Associated with Contrast-Associated Acute Kidney Injury Following Endovascular Treatment for Intracranial Aneurysm

Inflammation is a major pathophysiologic mechanism of contrast-associated acute kidney injury (CA-AKI). This study investigated the association between preoperative neutrophil percentage-to-albumin ratio (NPAR), a novel systemic inflammatory index, and CA-AKI, and compared its discriminative ability for CA-AKI with that of other preoperative systemic inflammatory indices in patients who underwent endovascular treatment for intracranial aneurysms.

Perioperative data were retrospectively collected and analyzed from 2,759 adult patients who underwent endovascular treatment for intracranial aneurysms. Based on the optimal cutoff value of preoperative NPAR, patients were categorized into high (NPAR ≥ 14.55; n = 836) and low (NPAR < 14.55; n = 1,923) NPAR groups. After propensity score matching (PSM), 697 patients were selected from each group. CA-AKI was defined as an increase in serum creatinine concentrations of ≥ 25% or ≥ 0.5 mg/dL from preoperative baseline within 72 hours after contrast administration.

CA-AKI occurred more frequently in the high NPAR group before (46 [5.5%] vs. 42 [2.2%], p < 0.001) and after (39 [5.6%] vs. 19 [2.7%], p = 0.007) PSM. A high preoperative NPAR was independently associated with an increased risk of CA-AKI before (odds ratio [95% confidence interval] 1.85 [1.16-2.96], p = 0.010) and after (2.12 [1.21-3.70], p = 0.009) PSM. Among the eight preoperative systemic inflammatory indices evaluated, NPAR demonstrated the highest area under the receiver operating characteristics curve (0.622) for predicting CA-AKI.

A high preoperative NPAR was an independent predictor of CA-AKI following endovascular treatment for intracranial aneurysms.