PMID- 28087509 OWN - NLM STAT- MEDLINE DCOM- 20180109 LR - 20220318 IS - 2047-9980 (Electronic) IS - 2047-9980 (Linking) VI - 6 IP - 1 DP - 2017 Jan 13 TI - Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Contrast-Induced Acute Kidney Injury and Its Clinical Implications. LID - 10.1161/JAHA.116.004747 [doi] LID - e004747 AB - BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) was traditionally defined as an increase in serum creatinine (sCr) after contrast media exposure. Recently, serum cystatin C (sCyC) has been proposed as an alternative to detect acute changes in renal function. The clinical implications of combining sCyC and sCr to diagnose CI-AKI remain unknown. METHODS AND RESULTS: One thousand seventy-one consecutive patients undergoing coronary angiography/intervention were prospectively enrolled. SCyC and sCr were assessed at baseline and 24 to 48 hours after contrast media exposure. CI-AKI determined by sCr (CI-AKI(sCr)) was defined as an sCr increase greater than 0.3 mg/dL or 50% from baseline. Major adverse events at 12 months were assessed. CI-AKI(sCr) developed in 25 patients (2.3%). Twelve-month follow-up was available for 1063 patients; major adverse events occurred in 61 patients (5.7%). By receiver operating characteristic curve analysis, an sCyC increase of greater than 15% was the optimal cutoff for CI-AKI(sCr) detection, which occurred in 187 patients (17.4%). To evaluate the use of both sCyC and sCr as CI-AKI diagnostic criteria, we stratified patients into 3 groups: no CI-AKI, CI-AKI detected by a single marker, and CI-AKI detected by both markers. Multivariable logistic regression revealed that the predictability of major adverse events increased in a stepwise fashion in the 3 groups (no-CI-AKI group as the reference, CI-AKI detected by a single marker: odds ratio=2.25, 95% CI: 1.24-4.10, P<0.01; CI-AKI detected by both markers: odds ratio=10.00, 95% CI: 3.13-31.91, P<0.001). CONCLUSIONS: Combining sCyC and sCr to diagnose CI-AKI would be beneficial for risk stratification and prognosis in patients after contrast media exposure. CI - (c) 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. FAU - Zhang, Wei-Feng AU - Zhang WF AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. FAU - Zhang, Tuo AU - Zhang T AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. FAU - Ding, Ding AU - Ding D AD - Department of Biostatistics, Johns Hopkins University, Baltimore, MD. FAU - Sun, Shi-Qun AU - Sun SQ AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. FAU - Wang, Xiao-Lei AU - Wang XL AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. FAU - Chu, Shi-Chun AU - Chu SC AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. FAU - Shen, Ling-Hong AU - Shen LH AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China rjshenlinghong@126.com rjheben@126.com. FAU - He, Ben AU - He B AD - Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China rjshenlinghong@126.com rjheben@126.com. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20170113 PL - England TA - J Am Heart Assoc JT - Journal of the American Heart Association JID - 101580524 RN - 0 (Contrast Media) RN - 0 (Cystatin C) RN - AYI8EX34EU (Creatinine) SB - IM MH - Acute Kidney Injury/blood/chemically induced/*diagnosis MH - Aged MH - Cause of Death MH - China MH - Contrast Media/adverse effects MH - Creatinine/*blood MH - Cystatin C/*blood MH - Female MH - Humans MH - Kidney Failure, Chronic/epidemiology/therapy MH - Logistic Models MH - Male MH - Middle Aged MH - Mortality MH - Multivariate Analysis MH - Myocardial Infarction/epidemiology MH - Odds Ratio MH - Prognosis MH - ROC Curve MH - Renal Dialysis MH - Risk Assessment MH - Stroke/epidemiology PMC - PMC5523641 OTO - NOTNLM OT - contrast-induced acute kidney injury OT - diagnosis OT - prognosis OT - risk stratification EDAT- 2017/01/15 06:00 MHDA- 2018/01/10 06:00 PMCR- 2017/01/01 CRDT- 2017/01/15 06:00 PHST- 2017/01/15 06:00 [entrez] PHST- 2017/01/15 06:00 [pubmed] PHST- 2018/01/10 06:00 [medline] PHST- 2017/01/01 00:00 [pmc-release] AID - JAHA.116.004747 [pii] AID - JAH31977 [pii] AID - 10.1161/JAHA.116.004747 [doi] PST - epublish SO - J Am Heart Assoc. 2017 Jan 13;6(1):e004747. doi: 10.1161/JAHA.116.004747.