The Ratio of Contrast Volume/Glomerular Filtration Rate and Urine NGAL Predicts the Progression of Acute Kidney Injury to Chronic Kidney Disease in Patients After Planned Percutaneous Coronary Intervention

Figures & data

Figure 1 Study diagram.

Table 1 Comparison of Demographic and Laboratory Characteristics in CA-AKI Group and Non-AKI One

Clinical Characteristics and Laboratory Parameters	Total (n=387)	CA-AKI Group (n=44)	Non-AKI Group (n=343)	p
Ages (Years)	60.12 ± 9.89	66.52 ± 7.85	59.3 ± 9.83	< 0.001
Number of males (n,%)	257 (66.4)	32 (72.7)	225 (65.6)	0.346
Hypertension
Yes (n,%)	81 (20.9)	27 (61.4)	54 (15.7)	< 0.001
No (n,%)	306 (79.1)	17 (38.6)	289 (84.3)
Diabetic Mellitus
Yes (n,%)	67 (17.3)	25 (56.8)	42 (12.2)	< 0.001
No (n,%)	320 (82.7)	19 (43.2)	301 (87.8)
BMI (kg/m^2)
< 18.5 (n,%)	3 (0.8)	1 (2.3)	2 (0.6)	0.012
18.5–22.9 (n,%)	98 (25.4)	18 (40.9)	80 (23.4)
≥ 23.0 (n,%)	25 (56.8)	25 (56.8)	260 (76)
Mean	24.83 ± 3.15	23.38 ± 2.81	25.01 ± 3.15	0.001
Anemia (n,%)	83 (21.4)	11 (25)	72 (21)	0.542
Hemoglobin (g/L)	137.29 ± 16.85	135.09 ± 14.75	137.57 ± 17.1	0.359
Creatinine (µmol/L)	82 (73–92)	78 (66–87)	83 (74–93)	0.015
hs-CRP (mg/L)
> 2.0 (n,%)	271 (70.2)	23 (52.3)	248 (72.5)	0.006
Median	2.8 (1.9–4.5)	2.1 (1.6–5.45)	2.85 (1.97–4.5)	0.263
TnT-hs (ng/L)
> 14.0 (n,%)	261 (67.4)	31 (70.5)	230 (67.1)	0.651
Median	40.03 (10.39–278.5)	30.11 (11.25–301.57)	41 (10.39–278.5)	0.989
ALT (UI/L)
> 40.0	118 (30.5)	11 (25)	107 (31.2)	0.401
Median	31 (23–45)	29.5 (23–41.5)	32 (23–45)	0.395
AST (UI/L)
> 40.0	141 (36.4)	14 (31.8)	127 (37)	0.499
Median	34 (25–52)	34 (28.25–44.5)	34 (25–52)	0.663
Cholesterol (mmol/L)
≥ 5.2	122 (31.5)	11 (25)	111 (32.4)	0.322
Median	4.72 (3.69–5.52)	4.64 (3.58–5.38)	4.72 (3.74–5.53)	0.37
Triglyceride (mmol/L)
≥ 2.3	153 (39.5)	17 (38.6)	136 (39.7)	0.897
Median	2.03 (1.36–3.01)	2.03 (1.38–2.93)	2.03 (1.35–3.09)	0.635
LDL-C (mmol/L)
≥ 3.2	162 (41.9)	19 (43.2)	143 (41.7)	0.85
Median	2.9 (2.2–3.54)	2.8 (1.9–3.4)	2.9 (2.2–3.6)	0.092
HDL-C (mmol/L)
≤ 0.9	79 (20.4)	9 (20.5)	70 (20.4)	0.994
Median	1.15 (0.95–1.33)	1.13 (0.96–1.32)	1.15 (0.95–1.34)	0.852
Lipid disorder (n,%)	302 (78)	32 (72.7)	270 (78.7)	0.366
Na+ (mmol/L)	137.6 ± 3.44	137.36 ± 3.6	137.63 ± 3.43	0.631
K+ (mmol/L)	3.79 ± 0.36	3.8 ± 0.41	3.78 ± 0.35	0.76
EF%
< 50.0%	94 (24.3)	11 (25)	83 (24.2)	0.907
Median	62 (50–71)	62 (47–74.75)	62 (50–71)	0.604
Urine NGAL (ng/mL)	19.87 (13.22–27.6)	51.44 (44.1–67.7)	18.17 (12.71–23.19)	< 0.001
eGFR (mL/min/1.73m^2)
< 60	5 (1.3)	5 (11.4)	0 (0)	< 0.001
Median	72.74 (65.19–84.9)	63.82 (61.09–66.73)	74.1 (66.3–88.2)	< 0.001
Vc/eGFR ratio	1.5 (1.27–1.85)	2.27 (1.86–2.80)	1.47 (1.24–1.75)	< 0.001
Number of stents
1 (n,%)	245 (63.3)	13 (29.5)	232 (67.6)	< 0.001
2 (n,%)	80 (20.7)	9 (20.5)	71 (20.7)
3 (n,%)	62 (16)	22 (50)	40 (11.7)
Mean	1.53 ± 0.75	2.2 ± 0.87	1.44 ± 0.69	< 0.001
CA-AKI to CKD (n,%)	16 (4.13)	16 (36.36)	0 (0)	-

Note: Bold values: statistically significant difference.

Abbreviations: CA-AKI, Contract associated-Acute Kidney Injury; BMI, Body Mass Index; CRP-hs, C Reactive Protein-high sensitive; TnT-hs, Troponin T-high sensitive; ALT, Alanine Aminotransferase; AST, Aspartate Aminotransferase; LDL-C, Low-Density Lipoprotein Cholesterol; HDL-C, High-Density Lipoprotein Cholesterol; EF, Ejection Fraction; NGAL, Neutrophil Gelatinase-associated Lipocalin; eGFR, estimated Glomerular Filtration Rate; Vc, Contrast Drug Volume; CKD, Chronic Kidney Disease.

Table 2 Comparing Demographic and Laboratory Characteristics in CA-AKI to CKD Group and Recovery One

Clinical Characteristics and Laboratory Parameters	Total (n=44)	CA-AKI to CKD Group (n=16)	Recovery Group (n=28)	p
Ages (Years)	66.52 ± 7.85	64.81 ± 7.22	67.5 ± 8.15	0.28
Number of males (n,%)	32 (72.7)	12 (75)	20 (71.4)	1.000
Hypertension
Yes (n,%)	27 (61.4)	14 (87.5)	13 (46.4)	0.007
No (n,%)	17 (38.6)	2 (12.5)	15 (53.6)
Diabetic Mellitus
Yes (n,%)	25 (56.8)	14 (87.5)	11 (39.3)	0.002
No (n,%)	19 (43.2)	2 (12.5)	17 (60.7)
BMI (kg/m^2)
< 18.5 (n,%)	1 (2.3)	1 (6.3)	0 (0)	-
18.5–22.9 (n,%)	18 (40.9)	5 (31.3)	13 (46.4)
≥ 23.0 (n,%)	25 (56.8)	10 (62.5)	15 (53.6)
Mean	23.38 ± 2.81	22.99 ± 2.93	23.61 ± 2.77	0.489
Anemia (n,%)	11 (25)	4 (25)	7 (25)	1.000
Hemoglobin (g/L)	135.09 ± 14.75	135.87 ± 11.1	134.64 ± 16.66	0.793
Creatinine (µmol/L)	78 (66–87)	80 (71.5–87)	78 (63.5–87)	0.732
hs-CRP (mg/L)
> 2.0 (n,%)	23 (52.3)	7 (43.8)	16 (57.1)	0.392
Median	2.1 (1.6–5.45)	1.85 (1.52–7.6)	2.1 (1.72–4.7)	0.807
TnT-hs (ng/L)
> 14.0 (n,%)	31 (70.5)	12 (75)	19 (67.9)	0.738
Median	30.11 (11.25–301.57)	38.14 (12.02–695.55)	30.11 (8.49–260.47)	0.591
ALT (UI/L)
> 40.0	11 (25)	5 (31.3)	6 (21.4)	0.492
Median	29.5 (23–41.5)	31.5 (23.75–50.75)	28.5 (20–39.5)	0.427
AST (UI/L)
> 40.0	14 (31.8)	7 (43.8)	7 (25)	0.199
Median	34 (28.25–44.5)	36 (29.75–98.75)	33.5 (26.5–40.75)	0.246
Cholesterol (mmol/L)
≥ 5.2	11 (25)	5 (31.3)	6 (21.4)	0.492
Median	4.64 (3.58–5.38)	5.03 (4.04–5.7)	4.42 (3.27–5.15)	0.121
Triglyceride (mmol/L)
≥ 2.3	17 (38.6)	5 (31.3)	12 (42.9)	0.447
Median	2.03 (1.38–2.93)	1.74 (1.38–2.84)	2.07 (1.33–2.93)	0.705
LDL-C (mmol/L)
≥ 3.2	19 (43.2)	8 (50)	11 (39.3)	0.49
Median	2.8 (1.9–3.4)	3.05 (2.3–3.82)	2.55 (1.57–3.22)	0.035
HDL-C (mmol/L)
≤ 0.9	9 (20.5)	4 (25)	5 (17.9)	0.702
Median	1.13 (0.96–1.32)	1.05 (0.91–1.32)	1.17 (1.0–1.37)	0.479
Lipid disorder (n,%)	32 (72.7)	13 (81.3)	19 (67.9)	0.487
Na+ (mmol/L)	137.36 ± 3.6	137.19 ± 3.03	137.46 ± 3.93	0.81
K+ (mmol/L)	3.8 ± 0.41	3.76 ± 0.54	3.82 ± 0.32	0.676
EF%
< 50.0%	11 (25)	6 (37.5)	5 (17.9)	0.169
Median	62 (47–74.75)	53.5 (36.25–65)	68.5 (55–75.75)	0.022
Urine NGAL (ng/mL)	51.44 (44.1–67.7)	72.74 (65.76–78.18)	46.57 (42.15–55.45)	< 0.001
eGFR (mL/min/1.73m^2)
< 60	5 (11.4)	5 (31.3)	0 (0)	-
Median	63.82 (61.09–66.73)	60.87 (58.7–63.39)	64.95 (63.27–68.6)	0.001
Vc/eGFR ratio	2.27 (1.86–2.80)	2.82 (2.7–2.99)	1.93 (1.6–2.24)	< 0.001
Number of stents
1 (n,%)	13 (29.5)	1 (6.3)	12 (42.9)	0.001
2 (n,%)	9 (20.5)	1 (6.3)	8 (28.6)
3 (n,%)	22 (50)	14 (87.5)	8 (28.6)
Mean	2.2 ± 0.87	2.81 ± 0.54	1.86 ± 0.84	< 0.001

Note: Bold values: statistically significant difference.

Abbreviations: CA-AKI, Contract associated-Acute Kidney Injury; CKD, Chronic Kidney Disease; BMI, Body Mass Index; CRP-hs, C Reactive Protein-high sensitive; TnT-hs, Troponin T-high sensitive; ALT, Alanine Aminotransferase; AST, Aspartate Aminotransferase; LDL-C, Low-Density Lipoprotein Cholesterol; HDL-C, High-Density Lipoprotein Cholesterol; EF, Ejection Fraction; NGAL, Neutrophil Gelatinase-associated Lipocalin; eGFR, estimated Glomerular Filtration Rate; Vc, Contrast Drug Volume.

Table 3 Multivariate Logistic Regression Analysis of Some Clinical Variables Related to the Progression of CA-AKI to CKD

Variable	OR	95% Cl	p
Diabetes	78.18	2.14–2843.80	0.017
Vc/eGFR ratio	97.16	1.60–5893.40	0.029
uNGAL	1.22	1.03–1.44	0.021

Note: Bold values: statistically significant difference.

Abbreviations: CA-AKI, Contract associated-Acute Kidney Injury; CKD, Chronic Kidney Disease; eGFR, estimated Glomerular Filtration Rate; Vc, Contrast Drug Volume; uNGAL, Urine Neutrophil Gelatinase-associated Lipocalin.

Figure 2 Receiver-operating characteristic (ROC) curves of Age, CRP-hs, EF%, eGFR, Vc/eGFR and uNGAL for prediction of CA-AKI to CKD. Vc/eGFR ratio: AUC = 0.884; p < 0.001; cut-off value = 2.4; Sensitivity = 81.3%; Specificity = 89.3%; uNGAL: AUC = 0.878; p < 0.001; cut-off value = 58 ng/mL; Sensitivity = 81.3%; Specificity = 85.7%; eGFR: AUC = 0.808; p = 0.001; cut-off value = 63.08 mL/min/1.73m²; Sensitivity = 75%; Specificity = 78.6%; EF%: AUC = 0.709; p = 0.023; cut-off value = 64%; Sensitivity = 75%; Specificity = 60.7%).