Early prediction of acute kidney injury in patients with acute myocardial injury |
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Authors: | Ping-Gune Hsiao Chien-An Hsieh Chun-Fu Yeh Hsueh-Hua Wu Tzu-Fang Shiu Yung-Chang Chen Pao-Hsien Chu |
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Affiliation: | 1. The Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 105, Taiwan;2. Department of Internal Medicine, Chiayi Christian Hospital, Chiayi 600, Taiwan;3. Department of Internal Medicine, Buddhist Tzu Chi General Hospital Taipei Branch, Taipei 231, Taiwan;4. Department of Internal Medicine; Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 105, Taiwan;5. Department of Nephrology, Department of Internal Medicine; Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 106, Taiwan |
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Abstract: | IntroductionPrevious studies have revealed that acute myocardial infarction (AMI) with acute kidney injury (AKI), about 17%, is strongly related to long-term mortality and heart failure. The dynamic changes in renal function during AMI are strongly related to long-term mortality and heart failure.ObjectivesOur study used clinical parameters and AKI biomarkers including neutrophil gelatinase–associated lipocalin, interleukin (IL)-6, IL-18, and cystatin C to evaluate prognostic relevance of AKI in the setting of AMI.MethodsThis prospective study was conducted from November 2009 to January 2011 and enrolled sequential 96 patients with catheter-proven AMI; it was approved by the institutional review board of Chang Gung Memorial Hospital, Taiwan (institutional review board no. 99-0140B) and conformed to the tenets of the Declaration of Helsinki. The definition of AKI is the elevation of serum creatinine of more than 0.3 mg/dL within 48 hours.ResultsOur results show that the incidence of AKI after AMI is 17.7% (17 patients). The following could be statistically related to AKI after AMI: age (P = .012), cardiac functions (Killip stage and echocardiogram; P = .003 each), Thrombolysis in Myocardial Infarction (TIMI) flow grade (P < .001), stenting (P < .001), neutrophil gelatinase–associated lipocalin (P = .005), IL-6 (P = .01), IL-18 (P = .002), and cystatin C (P = .002) in serum. The TIMI flow grade and serum cystatin C were shown to be important predictors by using multivariate analysis. Both TIMI flow lower than grade 2 and serum cystatin C of more than 1364 mg/L could be used to predict AKI (both overall correctness, 0.78). Moreover, IL-6 in serum is also associated with the major cardiovascular events after AMI (P = .02), as demonstrated in our study.ConclusionIn conclusion, the worse TIMI flow and high plasma cystatin C can be used to predict AKI after AMI. Moreover, IL-6 can also be used as a 30-day major cardiovascular event indicator after AMI. A larger prospective and longitudinal study should follow the relationship between AKI predictors after AMI. |
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Keywords: | Acute kidney injury Acute myocardial infarction Biomarkers |
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