Microalbuminuria in non-diabetic stemi: An independent predictor for acute kidney injury

Figures & data

Table I. Clinical and angiographic characteristics of patients with ST elevation myocardial infarction included in the study.

	Mean ± SD or median (25th–75th percentile) or frequency (%)
Age (years, mean ± SD)	65.0 ± 13.0
Males/females, n (%)	396/130 (75/25)
History, n (%)
Smoking	354 (67)
COPD	33 (6)
Previous PCI	64 (12)
Previous MI	64 (12)
Hypertension	235 (45)
AMI location, n (%)
anterior	276 (52)
inferior	220 (42)
Other	30 (6)
Coronary artery disease, n (%)
1-vessel	214 (41)
2-vessel	172 (33)
3-vessel	140 (27)
LM, n (%)	39 (7)
CABG, n (%)	4 (1)
PCI failure, n (%)	31 (6)
Admission EF (%, mean ± SD)	43.9 ± 9.7
Discharge EF (%, mean ± SD)	45.1 ± 9.0
Symptom-to-balloon symptom time, minutes [median (25th–75th percentile)]	210 (156–320)
Length of stay [hours, median (25th–75th percentile)]	68 (48–96)
In-hospital mortality, n (%)	18 (3)

COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention; MI, myocardial infarction; AMI, acute myocardial infarction; LM, left main coronary artery; CABG, coronary artery bypass graft; EF, ejection fraction.

Table II. Comparison between patients with and without microalbuminuria.

	Microalbuminuria (n = 200, 38.0%)	No microalbuminuria (n = 326, 62.0%)	p-Value
Clinical data
Males/females [n (%)]	147/53 (74/26)	249/77 (76/24)	0.457 (χ^2)
Age (years, mean ± SD)	67 ± 12	64 ± 13	0.013 (t)
BMI (kg/m^2, mean ± SD)	26 ± 5	26 ± 4	0.881 (t)
AMI anterior, n (%)	106 (53)	169 (52)	0.751 (χ^2)
Killip class, n (%)			0.385 (χ^2)
I–II	181 (91)	302 (93)
III–IV	19 (9)	24 (7)
Admission EF (%, mean ± SD)	43 ± 10	46 ± 9	0.271 (t)
Discharge EF (%, mean ± SD)	44 ± 9	42 ± 10	0.142 (t)
PCI failure, n (%)	15 (8)	16 (5)	0.233 (χ^2)
Laboratory data
Microalbuminuria [µg/ml, median (25th–75th percentile)]	52.5 (35.9–95.2)	7.0 (4.0–11.8)	< 0.001 (U)
Admission glucose (mmol/l, mean ± SD	7.7 ± 2	7.4 ± 3	0.258 (t)
Peak glucose (mmol/l, mean ± SD)	8.9 ± 3	8.3 ± 3	0.017 (t)
Insulin [mUI/l, median (25th–75th pct)]	8 (5–15)	9 (5–15)	0.693 (U)
HOMA positivity, n (%)	13 (9)	22 (10)	0.742 (χ^2)
Glycated Hb (%, mean ± SD)	5.9 ± 0.8	5.9 ± 0.8	0.702 (t)
Glycated Hb > 6.5%	13/157 (8)	27/246 (11)	0.378 (χ^2)
Peak Tn I (ng/ml, mean ± SD)	104 (52–203)	73 (33–144)	< 0.001 (U)
NT-proBNP [pg/ml, median (25th–75th percentile)]	1460 (557–3332)	992 (389–2460)	0.020 (U)
Uric acid (µm/L, mean ± SD)	333 ± 101	339 ± 100	0.705 (t)
ESR [mm/h, median (25th–75th percentile)]	26 (14–41)	19 (10–35)	0.003 (U)
Leucocytes (× 10^3/µl, mean ± SD)	12.4 ± 3.9	11.1 ± 4.0	< 0.001 (t)
C-reactive protein (mg/dl)	10 (8–27)	9 (8–18)	0.020
Fibrinogen (µm/L, mean ± SD)	12.3 ± 3.4	11.8 ± 3.1	0.132 (t)
Estimated GFR at admission (ml/min/1.73 m^2, mean ± SD)	81 ± 25.4	86 ± 27.1	0.048 (t)
Estimated GFR at nadir (ml/min/1.73 m^2, mean ± SD)	70 ± 25	77 ± 26	0.003 (t)
In hospital mortality, n (%)	10 (5)	8 (3)	0.119 (χ^2)

χ², t and U refer to chi-square, Student's t and Mann–Whitney U tests, respectively.

BMI, body mass index; AMI, acute myocardial infarction; EF, ejection fraction; PCI, percutaneous intervention; HOMA, homeostatic model assessment; Tn, troponin; NT-proBNP, N terminal-pro brain natriuretic peptide; ESR, erythrocyte sedimentation rate; GFR, glomerular filtration rate.

Table III. Use of device and inotropic agents.

	Frequency (%)
	Microalbuminuria (n = 200, 38.0%)	No microalbuminuria (n = 326, 62.0%)	p-Value
Ventilatory support (MV and/or NIV)	22 (11)	20 (6)	0.046
CVVHDF	7 (4)	8 (3)	0.484
IABP	53 (27)	64 (20)	0.066
Inotropic agents
Norepinephrine	7 (4)	9 (3)	0.632
Dobutamine	6 (3)	10 (3)	0.965
Dopamine	37 (19)	30 (9)	0.002

MV, mechanical ventilation; NIV, non-invasive ventilation; CVVHDF, continuous venous–venous hemodiaultrafiltration; IABP, intra-aortic balloon pump.

Table IV. Multivariable regression analysis.

	OR	95% CI	p-Value
Composite end-point
Age (1 year step)	1.07	1.04–1.10	< 0.001
Peak Tn I (10 ng/ml step)	1.03	1.01–1.04	0.001
Admission glycemia (0.56 mmol/l step)	1.78	1.09–2.88	0.019
Microalbuminuria (10 µg/ml step)	1.08	1.01–1.05	0.021
Uric acid (59.5 µmol/l step)	1.16	0.99–1.37	0.063
Hosmer–Lemeshow chi-square 4.32, p = 0.827; Nagelkerke R^2 0.16
In-ICCU death
Age (1 year/step)	1.10	1.05–1.16	< 0.001
Microalbuminuria (10 µg/ml step)	1.06	0.96–1.17	0.237
Hosmer–Lemeshow chi-square 9.82, p = 0.278; Nagelkerke R^2 0.27
Acute kidney injury
Age (1 year/step)	1.05	1.02–1.08	< 0.001
Microalbuminuria (10 µg/ml step)	1.07	1.01–1.14	0.039
Peak Tn I (10 ng/ml step)	1.01	0.99–1.01	0.272
Hosmer–Lemeshow chi-square 8.21, p = 0.413; Nagelkerke R^2 0.12

Figure 1. Kaplan–Meier survival curves.