The relationship between pre-procedural elevated arterial lactate and contrast-induced nephropathy following primary percutaneous coronary intervention

Jun-Qing Yang; Xiao-Sheng Guo; Peng Ran; Xiang-Ming Hu; Ning Tan

doi:10.21037/jtd-21-1153

The relationship between pre-procedural elevated arterial lactate and contrast-induced nephropathy following primary percutaneous coronary intervention

J Thorac Dis. 2021 Sep;13(9):5467-5476. doi: 10.21037/jtd-21-1153.

Authors

Jun-Qing Yang^{1

2}, Xiao-Sheng Guo³, Peng Ran², Xiang-Ming Hu^{1

2}, Ning Tan^{1

2}

Affiliations

¹ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
² Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Department of Intensive Care Unit, Zhuhai Golden Bay Center Hospital, Guangdong Provincial People's Hospital Zhuhai Hospital, Zhuhai, China.

Abstract

Background: Risk stratification has been one of the main steps in preventing contrast-induced nephropathy (CIN), which is a common complication after percutaneous coronary intervention (PCI). Elevated arterial lactate is a biomarker indicating severe disease condition and post-intervention complications. The relationship between lactate and CIN has not been established. This study is performed to investigate the relationship between elevated arterial lactate level and contrast-induced nephropathy (CIN).

Methods: Patients diagnosed with ST-segment elevated myocardial infarction (STEMI) were prospectively enrolled, with lactate measured within 0.5-1 hours before primary percutaneous coronary intervention (PCI). Patients with cardiopulmonary resuscitation, any forms of severe anaerobic condition, or end-stage renal disease undergoing dialysis were excluded. CIN was defined as an increase in serum creatinine ≥0.5 mg/dL or 25% within 72 hours after PCI. The Mehran Risk Score (MRS) is widely regarded as a classic risk model for CIN and the risk factors of MRS were applied in our multivariate regression analysis.

Results: Of the 227 enrolled patients, 47 (20.7%) developed CIN according to the definition. The mean lactate level was higher in the CIN group than in the non-CIN group (2.68±2.27 vs. 1.74±1.94, P<0.001). The arterial lactate level ≥2.0 mmol/L had 57.5% sensitivity and 75.6% specificity in predicting CIN. The performance of the lactate level in discriminating CIN was similar to that of the MRS (AUC_lac =0.707 vs. AUC_MRS =0.697, P=0.86). After adjusting for other risk factors, lactate ≥2.0 mmol/L still significantly predicted CIN (odds ratio =3.77, 95% CI, 1.77-7.99, P=0.001).

Conclusions: An arterial lactate level of ≥2.0 mmol/L is associated with CIN in STEMI patients after primary PCI.

Keywords: Mehran Risk Score (MRS); ST-segment elevated myocardial infarction (STEMI); contrast-induced nephropathy (CIN); lactate; percutaneous coronary intervention (PCI).