Predictive Value of Systemic Inflammation Score for Contrast-Associated Acute Kidney Injury and Adverse Outcomes Among Patients Undergoing Elective Percutaneous Coronary Intervention

Ji-Lang Zeng; Yi-Fei Xiang; Li-Wei Zhang; Li-Chuan Chen; Jun-Han Chen; Wen-Jia Liang; Zhebin You; Chang-Xi Wang; Zhi-Jie Lin; Kai-Yang Lin; Yansong Guo

doi:10.2147/JIR.S419831

Predictive Value of Systemic Inflammation Score for Contrast-Associated Acute Kidney Injury and Adverse Outcomes Among Patients Undergoing Elective Percutaneous Coronary Intervention

J Inflamm Res. 2023 Jul 8:16:2845-2854. doi: 10.2147/JIR.S419831. eCollection 2023.

Authors

Ji-Lang Zeng^#^{1

2

3}, Yi-Fei Xiang^#^{1

2

3}, Li-Wei Zhang^#^{1

2

3}, Li-Chuan Chen^{1

2

3}, Jun-Han Chen^{1

2

3}, Wen-Jia Liang^{1

2

3}, Zhebin You^{2

3

4}, Chang-Xi Wang^{1

2

3}, Zhi-Jie Lin^{1

2

3}, Kai-Yang Lin^{1

2

3}, Yansong Guo^{1

2

3}

Affiliations

¹ Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People's Republic of China.
² Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People's Republic of China.
³ Fujian Heart Failure Center Alliance, Fuzhou, People's Republic of China.
⁴ Fujian Key Laboratory of Geriatrics, Department of Geriatric Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Geriatrics, Fujian Medical University, Fuzhou, Fujian, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Prior research has demonstrated a key role of systemic inflammatory state in the pathogenesis and progression of contrast-associated acute kidney injury (CA-AKI). Recently, the systemic inflammation score (SIS) has been introduced to evaluate the inflammatory status, utilizing the lymphocyte-to-monocyte ratio (LMR) and albumin. The primary objective of this study was to determine whether the SIS can predict CA-AKI and long-term prognosis in patients undergoing elective percutaneous coronary intervention (PCI).

Patients and methods: A total of 5726 patients who underwent elective PCI were included from January 2012 to December 2018. The primary outcome was CA-AKI, defined as an increase in serum creatinine (SCr) ≥0.3 mg/dl or ≥50% than baseline SCr within 48 h after the PCI procedure. The secondary outcome was long-term mortality. All patients were classified into low- and high-SIS groups.

Results: During hospitalization, 349 (6.1%) patients developed CA-AKI. Multivariate logistic regression analysis showed that patients in the high SIS group had a 1.47-fold higher risk of developing CA-AKI than those in the low SIS group [odds ratio (OR): 1.50, 95% confidence interval (CI): 1.12-2.01, P =0.006]. Furthermore, the SIS showed the greatest prediction performance for CA-AKI compared with other inflammatory hematological ratios. In the multivariate Cox regression analysis, the high SIS group was found to be closely associated with long-term mortality [hazard ratio (HR): 1.58, 95% CI: 1.26-1.97, P <0.001, vs low SIS group]. The Kaplan-Meier curve analysis also demonstrated a difference in long-term mortality between the two groups (Log rank test, P <0.001).

Conclusion: The SIS was closely associated with CA-AKI and long-term mortality in patients after elective PCI. Thus, more attention should be paid to exploring the potential benefits of anti-inflammatory strategies in preventing CA-AKI and improving the prognosis of patients undergoing PCI.

Keywords: contrast-associated acute kidney injury; mortality; percutaneous coronary intervention; systemic inflammation score.

Grants and funding

This research was supported by the National Natural Science Foundation of China General Program (Grant numbers: 81873495 and 82171569), the Heart Failure Center Research Foundation of Fujian Provincial Hospital (supported by the Fujian Provincial Department of Finance), and the National Key Clinical Specialty Construction Project of China (Cardiovascular Medicine 2021). The funding source had no role in this manuscript.