Early Prediction Of Contrast Induced Nephropathy Value Of Serum Cystatin C Combined With High Sensitive C Reactive Protein In Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Objective: The purpose of tihis study was to evaluate the predictive value of serum cystatin C(Cys C) combined with high sensitive C(Hs-CRP) reactive protein on contrast induced nephropathy(CIN) in patients with coronary heart disease(CAD) after percutaneous coronary intervention(PCI).Our aim was to to provide scientific basis for clinical prevention,early diagnosis,and treatment of contrast induced nephropathy.Methods:Three-hundred consecutive patients(mean age,68.23±8.85 years and male 64%) with coronary heart disease undergonging percutaneous coronary intervention from July of 2014 to December 2014 hospitalized in Cardiovascular department of internal medicine of the Xinjiang Uygur Autonomous Region people’s Hospital were enrolled in our study.All patients met the diagnostic criteria of ACC/AHA and WHO.Acquisition age and gender of patients,height,weight,blood pressure(pressure,diastolic pressure and mean pressure containing contraction),complicated with hypertension or diabetes,application of ACEI/ARB drugs basic information,and in the preoperative examination of renal function,blood lipids,blood glucose,heart function(EF value)etc.Estimated glomerular filtration rate(e GFR) was calculated by modification of diet in renal disease(MDRD)formula:e GFR(ml·min-1·1.73m-2)=175×SCr(mg/dl)-1.234×Age-0.179×(0.79 female).CIN was defined as a rise in SCr of 44.2 umol/L or a 25% increase from the baseline value.SCr,Cys C,BUN,Hs-CRP were measured on admission,12 hours(hs),24 hs,48hs,72 hs after PCI.All patients were arranged to CIN group and Non-CIN group based on presence of CIN.Resluts:All of 300 patients with undergoing PCI were enrolled in our study,among those,37 patients developed CIN,the incidence of CIN was 12.3%.Cys C and Hs-CRP level at 24 hs after PCI were significantly higher in CIN group.Older age,diabetes mellitus, hypertension,previous miocardial infarction(MI),previousPCI,chronic total occlusion(CTO),left ventricular end-diastolic diameter(LVD)≥55mm,the usage of contrast volume≥300ml during procedure were significant correlation with CIN.ROC curve analysis showed that at a cutoff of 1.37,Cys C exhibited89.2%(95%CI:83.0-95.4)sensitivity and 73%(95%CI:64.2-81.9)specificity,Youden index:0.622.ROC curve analysis showed that at a cutoff of 2.38,Hs-CRP exhibited75.7%(95%CI:67.2-84.3)sensitivity and 71.9%(95%CI:62.2-80.2)specificity,Youden index:0.476.When Cys C and Hs-CRP were combined,the sensitivity was improved using parallel testing,the specificity was decreased meanwhile.However,the specificity was improved using serial testing,the sensitivity was decreased meanwhile.Multi variate logistic regression analysis showed that older age,diabetes mellitus,previous miocardial infarction,chronic heart failure,intra-aortic balloon pump,the usage of contrast volume≥300ml during procedure were an indepengdent predictors of CIN.Conclusions:Cys C combination with Hs-CRP has higher predictive value for early diagnostic on CIN.