Öz
Amaç
Kontrast maddeye bağlı akut böbrek hasarı (CI-AKI), perkütan koroner girişim (PKG) uygulanan akut koroner sendrom (AKS) hastalarında önemli bir komplikasyondur. Bu çalışma, CI-AKI riskini öngörmede Naples prognostik skoru (NPS) ve beslenme durumunun kontrolü (CONUT) skorlarının prediktif değerini değerlendirmeyi amaçlamaktadır.
Yöntem
Ocak 2019-Aralık 2022 tarihleri arasında, PKG uygulanan 520 AKS hastasının verileri retrospektif olarak analiz edilmiştir. Hastalar, serum albümin, kolesterol ve enflamatuvar hücre sayımlarına dayalı olarak NPS ve CONUT skorlarına göre sınıflandırılmıştır. CI-AKI, kontrast sonrası böbrek fonksiyonlarında akut bozulma olarak tanımlanmıştır. Lojistik regresyon ve ROC analizleri ile NPS ve CONUT skorlarının prediktif değerleri değerlendirilmiştir.
Bulgular
CI-AKI, 142 hastada (%27,3) gelişmiştir. Yüksek NPS ve CONUT skorları, CI-AKI riskinde anlamlı artış ile ilişkili bulunmuştur (p<0,001). Çok değişkenli analizde, NPS ve CONUT skorları CI-AKI için bağımsız prediktörler olarak belirlenmiştir (olasılık oranı: 0,060, p=0,002; olasılık oranı 0,442, p=0,008). ROC analizi, yüksek prediktif doğruluk göstermiştir (NPS için AUC: 0,950; CONUT için AUC: 0,930).
Sonuç
NPS ve CONUT skorları, PKG uygulanan AKS hastalarında CI-AKI riskini etkili şekilde öngörebilmektedir. Bu skorların rutin kullanımı, risk sınıflandırması ve önleyici stratejilerin geliştirilmesine katkı sağlayabilir.
Anahtar Kelimeler: Akut koroner sendrom, CONUT skoru, kontrast ilişkili akut böbrek hasarı, Naples prognostik skoru, perkütan koroner girişim
Kaynakça
Tehrani S, Laing C, Yellon DM, Hausenloy DJ. Contrast-induced acute kidney injury following PCI. Eur J Clin Invest. 2013;43(5):483-490.
Xie W, Liang X, Lin Z, Liu M, Ling Z. Latest clinical evidence about effect of acetylcysteine on preventing contrast-induced nephropathy in patients undergoing angiography: a meta-analysis. Angiology. 2021;72(2):105-121.
He H, Chen XR, Chen YQ, Niu TS, Liao YM. Prevalence and predictors of contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI): a meta-analysis. J Interv Cardiol. 2019;2019:2750173.
Azzalini L, Spagnoli V, Ly HQ. Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol. 2016;32(2):247-255.
Goldenberg I, Matetzky S. Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ. 2005;172(11):1461-7141. Erratum in: CMAJ. 2005;173(10):1210.
Fan PC, Chen TH, Lee CC, Tsai TY, Chen YC, Chang CH. ADVANCIS score predicts acute kidney injury after percutaneous coronary intervention for acute coronary syndrome. Int J Med Sci. 2018;15(5):528-535.
McCullough PA, Adam A, Becker CR, Davidson C, Lameire N, Stacul F, et al; CIN Consensus Working Panel. Risk prediction of contrast-induced nephropathy. Am J Cardiol. 2006;98(6A):27K-36K.
Yang Z, Qiao Y, Wang D, Yan G, Tang C. Association between inflammatory biomarkers and contrast-induced acute kidney injury in ACS patients undergoing percutaneous coronary intervention: a cross-sectional study. Angiology. 2024;75(9):831-840.
Li C, Xu L, Guan C, Zhao L, Luo C, Zhou B, et al. Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China. Br J Nutr. 2020;123(3):337-346.
Goldfarb M, Lauck S, Webb JG, Asgar AW, Perrault LP, Piazza N, et al. Malnutrition and mortality in frail and non-frail older adults undergoing aortic valve replacement. Circulation. 2018;138(20):2202-2211.
Xiang X, Zhu X, Zhang L. Association of malnutrition with risk of acute kidney injury: a systematic review and meta-analysis. Int J Clin Pract. 2023;2023:9910718.
Dai L, Golembiewska E, Lindholm B, Stenvinkel P. End-stage renal disease, inflammation and cardiovascular outcomes. Contrib Nephrol. 2017;191:32-43.
Kurtul A, Gok M, Esenboga K. Prognostic nutritional index predicts contrast-associated acute kidney injury in patients with ST-segment elevation myocardial infarction. Acta Cardiol Sin. 2021;37(5):496-503.
Jiang H, Li D, Xu T, Chen Z, Shan Y, Zhao L, et al. Systemic immune-inflammation index predicts contrast-induced acute kidney injury in patients undergoing coronary angiography: a cross-sectional study. Front Med (Lausanne). 2022;9:841601.
Kılıç O, Suygun H, Mustu M, Ozpamuk Karadeniz F, Ozer SF, Senol H, et al. Is the Naples prognostic score useful for predicting heart failure mortality. Kardiologiia. 2023;63(3):61-65.
Saygi M, Tanalp AC, Tezen O, Pay L, Dogan R, Uzman O, et al. The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction. Coron Artery Dis. 2024;35(1):31-37.
Yang Q, Chen T, Yao Z, Zhang X. Prognostic value of pre-treatment Naples prognostic score (NPS) in patients with osteosarcoma. World J Surg Oncol. 2020;18(1):24.
Correction to: 2023 ESC Guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2024;45(13):1145.
Takahashi T, Watanabe T, Otaki Y, Kato S, Tamura H, Nishiyama S, et al. Prognostic significance of the controlling nutritional (CONUT) score in patients with acute coronary syndrome. Heart Vessels. 2021;36(8):1109-1116.
Wada H, Dohi T, Miyauchi K, Jun S, Endo H, Doi S, et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease. J Cardiol. 2018;72(2):155-161.
Weisbord SD, Palevsky PM, Kaufman JS, Wu H, Androsenko M, Ferguson RE, et al; PRESERVE Trial Investigators. Contrast-associated acute kidney injury and serious adverse outcomes following angiography. J Am Coll Cardiol. 2020;75(11):1311-1320.
Arero G, Arero AG, Mohammed SH, Vasheghani-Farahani A. Prognostic potential of the controlling nutritional status (CONUT) score in predicting all-cause mortality and major adverse cardiovascular events in patients with coronary artery disease: a meta-analysis. Front Nutr. 2022;9:850641.
Chen L, Huang Z, Li W, He Y, Liang J, Lu J, et al. Malnutrition and the risk for contrast-induced acute kidney injury in patients with coronary artery disease. Int Urol Nephrol. 2022;54(2):429-435.
Wei X, Chen H, You Z, Yang J, He H, He C, et al. Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention. Clin Exp Nephrol. 2021;25(9):953-962.
Wiedermann CJ, Wiedermann W, Joannidis M. Causal relationship between hypoalbuminemia and acute kidney injury. World J Nephrol. 2017;6(4):176-187.
Murat SN, Kurtul A, Yarlioglues M. Impact of serum albumin levels on contrast-induced acute kidney injury in patients with acute coronary syndromes treated with percutaneous coronary intervention. Angiology. 2015;66(8):732-737.
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. Erratum in: Eur Heart J. 2020;41(44):4255.
Obialo CI, Okonofua EC, Nzerue MC, Tayade AS, Riley LJ. Role of hypoalbuminemia and hypocholesterolemia as copredictors of mortality in acute renal failure. Kidney Int. 1999;56(3):1058-1063.
Park CH, Kang EW, Park JT, Han SH, Yoo TH, Kang SW, et al. Association of serum lipid levels over time with survival in incident peritoneal dialysis patients. J Clin Lipidol. 2017;11(4):945-954.e3.
Bian C, Wu Y, Shi Y, Xu G, Wang J, Xiang M, et al. Predictive value of the relative lymphocyte count in coronary heart disease. Heart Vessels. 2010;25(6):469-473.
Zorlu C, Koseoglu C. Comparison of the relationship between inflammatory markers and contrast-induced nephropathy in patients with acute coronary syndrome after coronary angiography. Angiology. 2020;71(3):249-255.
Bansal S, Patel RN. Pathophysiology of contrast-induced acute kidney injury. Interv Cardiol Clin. 2020;9(3):293-298.
Akcay A, Nguyen Q, Edelstein CL. Mediators of inflammation in acute kidney injury. Mediators Inflamm. 2009;2009:137072.
Galizia G, Lieto E, Auricchio A, Cardella F, Mabilia A, Podzemny V, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum. 2017;60(12):1273-1284.
Xiong J, Hu H, Kang W, Liu H, Ma F, Ma S, et al. Prognostic impact of preoperative Naples prognostic score in gastric cancer patients undergoing surgery. Front Surg. 2021;8:617744.
Feng JF, Zhao JM, Chen S, Chen QX. Naples prognostic score: a novel prognostic score in predicting cancer-specific survival in patients with resected esophageal squamous cell carcinoma. Front Oncol. 2021;11:652537.
Arfsten H, Cho A, Prausmüller S, Spinka G, Novak J, Goliasch G, et al. Inflammation-based scores as a common tool for prognostic assessment in heart failure or cancer. Front Cardiovasc Med. 2021;8:725903.
Zhou Z, Liang M, Wu H, Huang S, Weng R, Hou J, et al. Preoperative lymphocyte-to-monocyte ratio as a prognostic predictor of long-term mortality in cardiac surgery patients: a propensity score matching analysis. Front Cardiovasc Med. 2021;8:639890.
Karauzum I, Karauzum K, Acar B, Hanci K, Bildirici HIU, Kilic T, et al. Predictive value of lymphocyte-to-monocyte ratio in patients with contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome. J Transl Int Med. 2021;9(2):123-130.
Chandiramani R, Cao D, Nicolas J, Mehran R. Contrast-induced acute kidney injury. Cardiovasc Interv Ther. 2020;35(3):209-217.
Heyman SN, Rosenberger C, Rosen S, Khamaisi M. Why is diabetes mellitus a risk factor for contrast-induced nephropathy? Biomed Res Int. 2013;2013:123589.
