Elevated Serum Uric Acid/Albumin Ratio as a Predictor of Post-Contrast Acute Kidney Injury After Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction

Figures & data

Table 1 Baseline Characteristics of Patients Stratified by Tercile of the sUAR

Variables	Q1 (n=953) sUAR<9.409	Q2 (n=954) 9.409≤sUAR<12.260	Q3 (n=954) sUAR≥12.260	P value
Demographics and clinical characteristics
Age, years	60.20±11.73	61.55±12.01	65.52±12.29	<0.001
Male, n (%)	749 (78.6)	821 (86.1)	792 (83.0)	<0.001
SBP, mm Hg	123.51±21.46	122.58±20.66	121.34±23.50	0.095
DBP, mm Hg	75.47±13.78	74.85±13.08	73.01±13.76	<0.001
Killip classification
I	743 (78.0)	699 (73.3)	544 (57.0)	<0.001
II	160 (16.8)	199 (20.9)	239 (25.1)
III	22 (2.3)	32 (3.4)	105 (11.0)
IV	28 (2.9)	24 (2.5)	65 (6.8)
Comorbidities, n (%)
Current smoking	393 (41.2)	430 (45.1)	337 (35.3)	<0.001
Hypertension	418 (43.9)	475 (49.8)	591 (61.9)	<0.001
Diabetes mellitus	279 (29.3)	258 (27.0)	306 (32.1)	0.054
Hyperlipidemia	117 (12.3)	143 (15.0)	111 (11.6)	0.069
Anemia	243 (25.5)	281 (29.5)	402 (42.1)	<0.001
COPD	16 (1.7)	20 (2.1)	32 (3.4)	0.044
Previous MI	216 (22.7)	221 (23.2)	237 (24.8)	0.502
Prior PCI	82 (8.6)	83 (8.7)	98 (10.3)	0.367
Prior stroke	48 (5.0)	51 (5.3)	111 (11.6)	<0.001
Laboratory measurements
Uric acid, mg/L	280.49±54.07	381.27±48.14	523.22±109.64	<0.001
Albumin, g/L	36.44±3.96	35.49±3.98	33.30±4.51	<0.001
LVEF, %	53.03±10.50	52.10±11.56	48.09±12.55	<0.001
Hemoglobin, g/L	136.22±18.93	135.38±20.16	129.78±21.95	<0.001
Baseline creatinine, mg/dL	0.94±0.69	1.08±0.86	1.49±1.12	<0.001
eGFR, mL/min	99.75±29.64	87.68±27.98	64.34±27.68	<0.001
HbA1c, %	6.00 (5.60~7.30)	6.10 (5.70~6.90)	6.10 (5.80~7.10)	0.041
Total cholesterol, mmol/L	4.94±1.19	4.96±1.23	4.75±1.28	<0.001
LDL-C, mmol/L	3.22±0.98	3.28±1.00	3.12±1.03	0.002
HDL-C, mmol/L	1.04±0.26	0.99±0.24	0.95±0.27	<0.001
Triglycerides, mmol/L	1.59±1.24	1.64±1.13	1.68±1.05	0.197
Prior medication use, n (%)
Aspirin	936 (98.2)	942 (98.7)	938 (98.3)	0.621
Clopidogrel	836 (87.7)	838 (88.0)	855 (89.6)	0.401
Ticagrelor	138(14.5)	165(17.3)	132(13.8)	<0.001
GP IIb/IIIa inhibitor	336(35.3)	372(39.0)	370(38.8)	0.169
Warfarin	11(1.2)	11(1.2)	21(2.2)	0.096
Statins	936 (98.2)	943 (98.8)	918 (96.2)	<0.001
Beta-blockers	823 (86.4)	801 (84.0)	737 (77.3)	<0.001
ACEI/ARB	789 (82.8)	781 (81.9)	737 (77.3)	0.005
Angiography
Multi-vessel stenosis, n (%)	643(67.5)	679 (71.2)	770 (80.7)	<0.001
No. of stents used	1.40±1.29	1.46±0.92	1.63±3.31	0.043
Length of stents, mm	35.09±22.56	37.53±26.15	39.54±25.30	<0.001
Contrast volume, mL	111.52±38.91	117.66±42.56	122.12±42.64	<0.001
Length of hospital stay, days	6.00(5.00~8.00)	7.00(5.00~8.00)	8.00(6.00~12.00)	<0.001

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; COPD, chronic obstructive pulmonary disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; LVEF, left ventricular ejection fraction; WBC, white blood cell; eGFR, estimated glomerular filtration rate; HbA1c, glycosylated hemoglobin; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin receptor blocker.

Figure 1 Study flowchart of the enrolled patients.

Table 2 Multivariable Logistic Regression Analysis for the sUAR as Continuous Variable

Variables	PC-AKI			In-Hospital MACEs
	OR	95% CI	P value	OR	95% CI	P value
sUAR, per 1-unit increase	1.06	1.02~1.10	0.005	1.02	0.98~1.06	0.354
eGFR	0.98	0.98~0.99	<0.001	0.99	0.98~0.99	<0.001
Age	1.03	1.02~1.05	<0.001	1.02	1.00~1.04	0.038
Female	0.67	0.43~1.05	0.080	1.22	0.78~1.90	0.395
Killip classification	1.91	1.35~2.71	<0.001	2.62	1.81~3.79	<0.001
Anemia	1.02	0.72~1.45	0.893	0.87	0.60~1.27	0.476
Current smoking	0.86	0.59~1.27	0.460	1.10	0.74~1.64	0.641
Diabetes	1.59	1.12~2.24	0.009	1.05	0.72~1.54	0.784
Hypertension	0.95	0.67~1.36	0.789	0.85	0.59~1.22	0.380
COPD	0.70	0.29~1.66	0.417	1.22	0.53~2.76	0.642
Previous MI	0.50	0.31~0.80	0.004	0.74	0.47~1.18	0.207
Prior PCI	0.81	0.49~1.33	0.399	0.75	0.44~1.29	0.298
Prior stroke	1.89	1.21~2.96	0.005	1.61	0.98~2.62	0.059
Aspirin	0.82	0.26~2.53	0.729	0.50	0.18~1.42	0.193
GP IIb/IIIa inhibitor	1.02	0.72~1.45	0.919	1.53	1.07~2.19	0.020
Multi-vessel stenosis	1.08	0.76~1.56	0.658	1.47	0.99~2.21	0.059
PCI access	1.41	0.96~2.07	0.076	2.20	1.51~3.21	<0.001

Abbreviations: eGFR, estimated glomerular filtration rate; COPD, chronic obstructive pulmonary disease; MI, myocardial infarction; PCI, percutaneous coronary intervention.

Table 3 Multivariable Logistic Regression Analysis for the sUAR as Categorical Variable

Variables	PC-AKI			In-Hospital MACEs
	OR	95% CI	P value	OR	95% CI	P value
Q1	Reference			Reference
Q2	1.18	0.69~2.01	0.541	0.70	0.42~1.14	0.150
Q3	1.85	1.12~3.06	0.016	0.86	0.54~1.39	0.546
eGFR	0.98	0.98~0.99	<0.001	0.98	0.98~0.99	0.000
Age	1.03	1.02~1.05	<0.001	1.02	1.00~1.04	0.035
Female	0.69	0.45~1.08	0.104	1.20	0.77~1.89	0.417
Killip classification	1.93	1.36~2.73	<0.001	2.67	1.84~3.86	<0.001
Anemia	1.05	0.74~1.48	0.800	0.88	0.61~1.28	0.504
Current smoking	0.87	0.59~1.28	0.482	1.12	0.75~1.67	0.595
Diabetes	1.61	1.14~2.27	0.007	1.05	0.72~1.52	0.817
Hypertension	0.93	0.66~1.33	0.708	0.86	0.60~1.24	0.413
COPD	0.71	0.30~1.69	0.444	1.19	0.52~2.72	0.684
Previous MI	0.49	0.30~0.78	0.003	0.73	0.46~1.16	0.179
Prior PCI	0.80	0.49~1.31	0.373	0.76	0.44~1.30	0.311
Prior stroke	1.88	1.21~2.95	0.005	1.61	0.99~2.64	0.056
Aspirin	0.81	0.26~2.51	0.718	0.51	0.18~1.44	0.204
GP IIb/IIIa inhibitor	1.00	0.70~1.42	0.990	1.55	1.08~2.22	0.017
Multi-vessel stenosis	1.08	0.76~1.55	0.658	1.47	0.98~2.20	0.059
PCI access	1.43	0.98~2.09	0.066	2.19	1.50~3.20	<0.001

Abbreviations: eGFR, estimated glomerular filtration rate; COPD, chronic obstructive pulmonary disease; MI, myocardial infarction; PCI, percutaneous coronary intervention.

Figure 2 Spline curve of the PC-AKI adjusted odds ratio (A) and the MACEs adjusted odds ratio (B).

Figure 3 Receiver operating characteristic curve analysis of the sUAR to predict PC-AKI and comparison of the AUC between the sUAR, uric acid, and albumin.