Predictive value of post-procedural early (within 24 h) increase in cystatin C for contrast-induced acute kidney injury and mortality following coronary angiography or intervention.

// Yong Liu 1,* , Kai-Hong Chen 2,* , Shi-Qun Chen 1,3,* , Li-Ling Chen 1,2,* , Chong-Yang Duan 4,* , Kun Wang 1,5,* , Xiao-Sheng Guo 1 , Hua-Long Li 1 , Wei-Jie Bei 1 , Kai-Yan Lin 1,3 , Ping-Yan Chen 4 , Ying Xian 6 , Ning Tan 1 , Ying-Ling Zhou 1,3 , Qing-Shan Geng 1 and Ji-Yan Chen 1 1 Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Key Laboratory of Coronary Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China 2 Department of Cardiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China 3 Department of Cardiology, Guangdong General Hospital Zhuhai Hospital, Zhuhai, Guangdong, China 4 National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China 5 Southern Medical University, Guangzhou, Guangdong, China 6 Duke Clinical Research Institute, Durham, NC, USA * These authors contributed equally to this work. Correspondence to: Ji-Yan Chen, email: // Qing-Shan Geng, email: // Ying-Ling Zhou, email: // Keywords : cystatin C, coronary angiography, percutaneous coronary intervention, contrast-induced acute kidney injury Received : March 03, 2017 Accepted : May 16, 2017 Published : July 06, 2017 Abstract Objective: To investigate the predictive value of post-procedural early (within 24 h) increase in cystatin C for contrast-induced acute kidney injury (CI-AKI) and all-cause mortality following coronary angiography or intervention. Methods: We prospectively investigated 1042 consecutive patients with both baseline and early post-procedural cystatin C measurement undergoing coronary angiography or intervention. CI-AKI was defined as an increase ≥0.3 mg/dL or >50% in serum creatinine from baseline within 48 h post-procedure. Mean follow-up was 2.26 years. Results: Overall, the patients had a CI-AKI incidence was 3.6% (38/1042), mean serum creatinine of 87 µmol/L. Compared with Mehran risk score, post-procedural early absolute increase (AUC: 0.584 vs . 0.706, P = 0.060) and relative increase (AUC: 0.585 vs . 0.706, P = 0.058) in cystatin C had poorer predictive value for CI-AKI. According to multivariate analysis, post-procedural significant early increase (≥0.3 mg/dL or ≥10%) in cystatin C developed in 231 patients (22.2%), was not independent predictor of CI-AKI (adjusted OR: 1.23, 95% CI, 0.56–2.69, P = 0.612), and long-term mortality (adjusted HR: 0.90; P = 0.838). Conclusions: Our data suggested post-procedural early increase (within 24 h) in cystatin C was not effective for predicting CI-AKI or all-cause mortality following coronary angiography or intervention among patients at relative low risk of CI-AKI, the negative finding of poor predictive value should be further evaluated in larger multicenter trials.