Association of N-terminal pro-brain natriuretic peptide with contrast-induced acute kidney injury and long-term mortality in patients with heart failure and mid-range ejection fraction An observation study

作者：Wang, Kun; Li, Hua-long; Chen, Li-ling; Bei, Wei-jie; Lin, Kai-yang; Smyth, Brendan; Chen, Shi-qun; Guo, Xiao-sheng; Guo, Wei; Liu, Yuan-hui; Chen, Peng-yuan; Chen, Ji-yan; Chen, Kai-hong^*; Liu, Yong; Tan, Ning^*

来源：Medicine, 2017, 96(10): e6259.

DOI：10.1097/MD.0000000000006259

• contrast-induced acute kidney injury
• heart failure and mid-range ejection fraction
• mortality
• N-terminal pro-brain natriuretic peptide

The potential value of N-terminal pro-brain natriuretic peptide (NT-proBNP) for contrast-induced acute kidney injury (CI-AKI) in patients with heart failure and mid-range ejection fraction (HFmrEF) is unclear. We investigated whether NT-proBNP is associated with CI-AKI and long-term mortality following elective cardiac catheterization in patients with HFmrEF. @@@ A total of 174 consecutive patients with HFmrEF undergoing elective coronary angiography or intervention were enrolled. The primary endpoint was the development of CI-AKI, defined as an absolute increase of >= 0.3mg/dL or >= 50% from baseline serum creatinine with 48hours after contrast medium exposure. Receiver-operating characteristic curve analysis was conducted, and Youden index was used to determine the best cutoff NT-proBNP value. Multivariable logistic regression and Cox proportional hazards regression analyses were performed to identify the independent risk factors for CI-AKI and long-term mortality, respectively. @@@ The incidence of CI-AKI was 12.1%. Patients with CI-AKI had higher NT-proBNP values than those without (4373[1561.9-7470.5] vs 1303[625.2-2482.3], P=0.003). Receiver-operating characteristic curve revealed that NT-proBNP was not significantly different from the Mehran risk score in predicting CI-AKI (area under the curve [AUC]=0.723 vs 0.767, P=0.516). The best cutoff NT-proBNP value for CI-AKI was 3299pg/mL, with 70.6% sensitivity and 83.1% specificity. Multivariable analysis demonstrated that NT-proBNP >= 3299pg/mL is significantly related to CI-AKI (odds ratio=12.79; 95% confidence interval, 3.18-51.49; P< 0.001). Cox regression analysis showed that NT-proBNP >= 3299pg/mL is associated with long-term mortality (adjusted hazard ratio=11.91; 95% CI, 2.16-65.70; P= 0.004) during follow-up. @@@ In patients with HFmrEF, NT-proBNP >= 3299pg/mL is associated with CI-AKI and long-term mortality following elective coronary angiography or intervention.

• 出版日期2017-3
• 单位华南理工大学; 福建省立医院; 广东省人民医院; 福建医科大学; 广东省心血管病研究所; 南方医科大学