CLINICAL RESEARCH
Serum albumin level as a predictor of contrast-induced acute kidney injury following coronary angiography
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1
Department of Cardiology, Westchester Medical Center, Valhalla, USA
2
Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, USA
3
Department of Cardiology, Kansas University Medical Center, KC, USA
4
Department of Nephrology, Beth Israel Deaconess Medical Center, Boston, MA
Submission date: 2020-04-25
Final revision date: 2020-04-27
Acceptance date: 2020-04-27
Publication date: 2020-05-15
Arch Med Sci Civil Dis 2020;5(1):29-34
KEYWORDS
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ABSTRACT
Introduction:
The association between serum albumin level and the risk of contrast-induced acute kidney injury (CI-AKI) after coronary angiography has not been well established.
Material and methods:
A retrospective chart review was performed for all patients who underwent coronary angiography with or without percutaneous coronary intervention (PCI) at a tertiary care medical center over a period of 5 years. CI-AKI was defined as an absolute increase in creatinine of 0.3 mg/dl from baseline within 48 h of contrast exposure. Mean pre-procedural albumin level was compared between patients who developed CI-AKI and those who did not. The optimal cut-off point was obtained from the receiver operating characteristic (ROC) curve and univariate multiple logistic regression analysis was used to assess the associated risk of CI-AKI.
Results:
Among 1319 patients (females = 32.3%, mean age: 58.2 ± 13.6 years) included in the study, 201 (15.2%) developed CI-AKI. Baseline serum albumin (3.5 vs. 3.8 gm/dl, p < 0.001) was significantly lower in patients who developed CI-AKI. ROC curve analysis revealed an optimal cutoff value for serum albumin of 3.85 gm/dl to predict CI-AKI with 67.2% sensitivity and 52.2% specificity (area under the curve (AUC) = 0.62, p < 0.001). Serum albumin < 3.85 gm/dl is significantly associated with higher risk of developing CI-AKI (adjusted odds ratio (AOR) = 1.5, 95% CI: 1.1–2.1, p = 0.02).
Conclusions:
Serum albumin < 3.85 gm/dl is an independent predictor of CI-AKI in patients undergoing coronary angiography.
REFERENCES (21)
1.
Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124: e574-651.
2.
Kocayigit I, Yaylaci S, Osken A, et al. Comparison of effects of thrombolytic therapy and primary percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction on in-hospital, six-month, and one-year mortality. Arch Med Sci Atheroscler Dis 2019; 4: 82-8.
3.
Chen C, Makkiya M, Aronow W, et al. Heightened risk of cardiac events following percutaneous coronary intervention for cocaine-associated myocardial infarction. Arch Med Sci 2020; 16: 66-70.
4.
Rear R, Bell RM, Hausenloy DJ. Contrast-induced nephropathy following angiography and cardiac interventions. Heart 2016; 102: 638-48.
5.
Seeliger E, Sendeski M, Rihal CS, et al. Contrast-induced kidney injury: mechanisms, risk factors, and prevention. Eur Heart J 2012; 33: 2007-15.
6.
Hossain MA, Costanzo E, Cosentino J, et al. Contrast-induced nephropathy: pathophysiology, risk factors, and prevention. Saudi J Kidney Dis Transpl 2018; 29: 1-9.
7.
Newhouse JH, Kho D, Rao QA, et al. Frequency of serum creatinine changes in the absence of iodinated contrast material: implications for studies of contrast nephrotoxicity. AJR Am J Roentgenol 2008; 191: 376-82.
8.
Lindsay J, Apple S, Pinnow EE, et al. Percutaneous coronary intervention-associated nephropathy foreshadows increased risk of late adverse events in patients with normal baseline serum creatinine. Catheter Cardiovasc Interv 2003; 59: 338-43.
9.
Solomon RJ, Mehran R, Natarajan MK, et al. Contrast-induced nephropathy and long-term adverse events: cause and effect? Clin J Am Soc Nephrol 2009; 4: 1162-9.
10.
Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol 2004; 44: 1393-9.
11.
Sreenivasan J, Zhuo M, Khan MS, et al. Anemia (hemoglobin 12. Dai DM, Wang D, Hu D, et al. Difference in hematocrit and plasma albumin levels as an additional biomarker in the diagnosis of infectious disease. Arch Med Sci 2020; 16: 522-30.
12.
El Habashy S, Adly A, Kader M, et al. Predictors of future microalbuminuria in children and adolescents with type 1 diabetes mellitus in Egypt. Arch Med Sci Atheroscler Dis 2019; 4: 286-97.
13.
Thomas ME, Blaine C, Dawnay A, et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87: 62-73.
14.
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: 732-7.
15.
Azzalini L, Spagnoli V, Ly HQ. Contrast-induced nephropathy: from pathophysiology to preventive strategies. Can J Cardiol 2016; 32: 247-55.
16.
Mehran R, Dangas GD, Weisbord SD. Contrast-associated acute kidney injury. N Engl J Med 2019; 380: 2146-55.
17.
Roche M, Rondeau P, Singh NR, et al. The antioxidant properties of serum albumin. FEBS Lett 2008; 582: 1783-7.
18.
Wiedermann CJ, Wiedermann W, Joannidis M. Hypoalbuminemia and acute kidney injury: a meta-analysis of observational clinical studies. Intensive Care Med 2010; 36: 1657-65.
19.
Kim S, McClave SA, Martindale RG, et al. Hypoalbuminemia and clinical outcomes: what is the mechanism behind the relationship? Am Surg 2017; 83: 1220-7.
20.
Lazaros G, Zografos T, Oikonomou E, et al. Usefulness of C-reactive protein as a predictor of contrast-induced nephropathy after percutaneous coronary interventions in patients with acute myocardial infarction and presentation of a new risk score (Athens CIN Score). Am J Cardiol 2016; 118: 1329-33.
21.
Choi H, Kim Y, Kim SM, et al. Intravenous albumin for the prevention of contrast-induced nephropathy in patients with liver cirrhosis and chronic kidney disease undergoing contrast-enhanced CT. Kidney Res Clin Pract 2012; 31: 106-11.