The Effect of Low-Dose Corticosteroids on Short- and Long-Term Renal Outcome in Patients with Cholesterol Crystal Embolism

Figures & data

Table 1. Clinical characteristics in the 51 patients with cholesterol crystal embolism

	All patients	Steroid therapy (+)	Steroid therapy (–)	p-Value
No. of patients	51	32	19
Age (years)	73.8 ± 6.8	74.0 ± 7.5	73.5 ± 5.5	0.62
Male	45 (88)	28 (88)	17 (89)	0.83
Hypertension	50 (98)	32 (100)	18 (95)	0.16
Diabetes mellitus	21 (41)	12 (38)	9 (47)	0.49
Dyslipidemia	37 (73)	24 (75)	13 (68)	0.61
Smoking	32 (63)	19 (59)	13 (68)	0.52
Ischemic heart disease	28 (55)	14 (44)	14 (74)	0.03
Cerebrovascular disease	18 (35)	11 (34)	7 (37)	0.86
Peripheral vascular disease	17 (33)	9 (28)	8 (42)	0.31
Abdominal and/or thoracic aortic aneurysm	16 (31)	11 (34)	5 (26)	0.55
Livedo and/or blue toes	47 (92)	31 (97)	16 (84)	0.11
Precipitating events
Angiography or cardiovascular surgery	27 (53)	15 (47)	12 (63)	0.26
Anticoagulation therapy	27 (53)	16 (50)	11 (58)	0.58
Iatrogenic forms	32 (63)	20 (62.5)	12 (63.2)	0.96
Spontaneous forms	19 (37)	12 (37.5)	7 (36.8)	0.96
ACEI and/or ARB	35 (69)	24 (75)	11 (58)	0.21
Statins	13 (25)	11 (34)	2 (11)	0.05
Systolic blood pressure (mmHg)	152 ± 32	151 ± 30	154 ± 35	0.81
Diastolic blood pressure (mmHg)	79 ± 19	78 ± 16	81 ± 23	0.49
Acute/subacute renal deterioration	13 (25)	7 (22)	6 (32)	0.45

Notes: Values are expressed as mean ± SD, or number (%). ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin II receptor blockers. p-Value: steroid therapy (+) versus steroid therapy (–).

Table 2. Renal or patient outcome in the 51 patients with cholesterol crystal embolism

	All patients	Steroid therapy (+)	Steroid therapy (–)	p-Value
Serum creatinine (mg/dL) (baseline)	2.0 (1.4–2.6)	2.0 (1.3–2.9)	1.9 (1.4–2.0)	0.32
Serum creatinine (mg/dL) (diagnosis)	2.9 (2.1–4.0)	3.0 (2.2–4.3)	2.9 (2.0–4.0)	0.44
Serum creatinine (mg/dL) (4 weeks)	2.3 (1.8–3.0)	2.4 (1.8–3.0)	2.2 (1.8–4.2)	0.92
% change in serum creatinine (4 weeks)	−13% (–29 to –3%)	−18% (–29 to –8%)	−5% (–26 to +4%)	0.03
Serum creatinine (mg/dL) (last follow-up)	2.5 (1.8–3.5)	2.5 (1.9–3.5)	2.5 (1.8–3.5)	0.72
% change per year in serum creatinine (last follow-up)	−8% (–21 to +6%)	−8% (–31 to +23%)	−7% (–16 to +1%)	0.80
eGFR (mL/min/1.73 m^2) (baseline)	26.6 (19.1–39.3)	25.3 (17.2–43.8)	27.4 (26.0–39.3)	0.27
eGFR (mL/min/1.73 m^2) (diagnosis)	17.0 (12.0–24.6)	16.4 (11.4–24.0)	17.9 (12.5–25.9)	0.40
eGFR (mL/min/1.73 m^2) (4 weeks)	21.2 (16.9–29.0)	20.6 (16.6 to 27.1)	24.7 (11.7–30.2)	0.81
% change in eGFR (4 weeks)	+17% (+3 to +45%)	+24% (+9 to +46%)	+5% (–4 to +38%)	0.03
eGFR (mL/min/1.73 m^2) (last follow-up)	19.3 (13.9–28.7)	19.1 (14.1–27.4)	20.1 (13.4–29.4)	0.70
% change per year in eGFR (last follow-up)	+11% (–6 to +32%)	+11% (–13 to +50%)	+11% (–1 to +27%)	0.81
Body mass index (kg/m^2) (diagnosis)	21.6 (19.7–24.1)	22.0 (19.9–24.4)	20.5 (19.7–23.8)	0.19
Body mass index (kg/m^2) (4 weeks)	21.1(19.6–23.4)	21.6 (20.3–23.5)	20.1 (18.6–22.7)	0.11
Body mass index (kg/m^2) (last follow-up)	21.0 (19.2–23.2)	21.1 (19.2–23.5)	20.8 (18.6–22.2)	0.38
Use of statins	36 (71)	25 (78)	11 (58)	0.13
Use of steroids	32 (63)	32 (100)	–	–
Duration of steroid therapy (months)	11.6 (2.4–34.8)	11.6 (2.4–34.8)	–	–
Initial dose of corticosteroids (mg/kg/day)	0.3 ± 0.1	0.3 ± 0.1	–	–
Follow-up period (months)	27.5 (10.7–48.8)	25.9 (12.2–50.2)	33.7 (8.5–48.8)	0.97
ESRD	7 (14)	5 (16)	2 (11)	0.70
Death	15 (29)	8 (25)	7 (37)	0.37

Notes: Values are expressed as mean ± SD, number (%), or median (interquartile range). eGFR, estimated glomerular filtration rate; ESRD, end-stage renal disease. p-Value: steroid therapy (+) versus steroid therapy (–).

Figure 1. The change of eGFR from diagnosis to 4 weeks after CCE diagnosis in patients with (A) and without steroid therapy (B). Note: eGFR, estimated glomerular filtration rate; CCE, cholesterol crystal embolism.

Table 3. Time course of eosinophils and C-reactive protein in the 51 patients with cholesterol crystal embolism

	All patients	Steroid therapy (+)	Steroid therapy (–)	p-Value
Eosinophil counts (/µL) (baseline)	312 (174–547)	317 (199–530)	304 (145–600)	0.94
Eosinophil counts (/µL) (diagnosis)	677 (520–891)	637 (522–810)	808 (486–1397)	0.21
Eosinophilia (diagnosis)	40 (78)	26 (81)	14 (74)	0.53
Eosinophil counts (/µL) (4 weeks)	187 (75–387)	120 (65–207)	520 (220–1011)	<0.01
% change in eosinophil counts (4 weeks)	−71% (–89 to –44%)	−83% (–90 to –65%)	−37% (–63 to –5%)	<0.01
Eosinophil counts (/µL) (last follow-up)	230 (117–441)	170 (101–390)	454 (139–675)	0.02
% change per year in eosinophil counts (last follow-up)	−38% (–119 to –16%)	−42% (–124 to –21%)	−18% (–110 to –7%)	0.15
C-reactive protein (mg/dL) (baseline)	0.23 (0.10–0.68)	0.21 (0.09–0.40)	0.37 (0.12–0.80)	0.14
C-reactive protein (mg/dL) (diagnosis)	0.87 (0.16–3.04)	0.76 (0.09–2.00)	0.87 (0.24–7.41)	0.07
C-reactive protein (mg/dL) (4 weeks)	0.18 (0.04–1.06)	0.09 (0.03–1.55)	0.30 (0.13–0.90)	0.17
% change in C-reactive protein (4 weeks)	−72% (–90 to –2%)	−68% (–88 to –1%)	75% (–91 to –11%)	0.60
C-reactive protein (mg/dL) (last follow-up)	0.39 (0.08–2.13)	0.25 (0.04–2.02)	0.49 (0.17–3.23)	0.05
% change per year in C-reactive protein (last follow-up)	−17% (–50 to +11%)	−22% (–56 to +2%)	−13% (–46 to +59%)	0.36

Notes: Values are expressed as number (%) or median (interquartile range). p-Value: steroid therapy (+) versus steroid therapy (–).

Table 4. Comparison of renal outcome in 25 patients with combination of steroids and statins and 11 patients with statins alone

	Combination (n = 25)	Satins alone (n = 11)	p-Value
eGFR (mL/min/1.73 m^2) (baseline)	23.3 (17.1–32.8)	29.1 (26.6–39.3)	0.11
eGFR (mL/min/1.73 m^2) (diagnosis)	15.9 (11.2–23.5)	17.9 (12.5–31.3)	0.20
eGFR (mL/min/1.73 m^2) (4 weeks)	19.3 (16.2–24.4)	24.8 (12.3–29.1)	0.66
% change in eGFR (4 weeks)	+28% (+10 to +46%)	+4% (–16 to +35%)	0.04
eGFR (mL/min/1.73 m^2) (last follow-up)	20.0 (13.9–27.1)	20.1 (13.4–29.4)	1.00
% change per year in eGFR (last follow-up)	+12% (–6 to +56%)	+4% (–2 to +27%)	0.66

Notes: Values are expressed as median (interquartile range). eGFR, estimated glomerular filtration rate.

Figure 2. The change of eGFR from diagnosis to 4 weeks (A) and last follow-up (B) in 11 CCE patients treated with statins alone. Note: eGFR, estimated glomerular filtration rate; CCE, cholesterol crystal embolism.