High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention.

BACKGROUND

Few studies have investigated hs-CRP as a risk factor for contrast-induced nephropathy (CIN). The aim of this study was to evaluate the predictive value of high-sensitivity C-reactive protein (hs-CRP) for risk of CIN in patients with acute ST-segment elevation myocardial infarction (STEMI) who were undergoing primary percutaneous coronary intervention (PCI).

METHODS

We prospectively observed 165 consenting patients with STEMI undergoing primary PCI. An increase in serum creatinine of more than 0.5 mg/dL from baseline within 48-72 hours of contrast media exposure was defined as CIN. Demographics, traditional risk factors, CIN incidence and other in-hospital clinical outcomes were compared among hs-CRP quartiles. Receiver operator characteristic curves were used to identify the optimal sensitivity for the observed range of hs-CRP. The predictive value of hs-CRP for the risk of CIN was assessed using multivariate logistic regression.

RESULTS

CIN occurred in 17 patients (10%). Univariate analysis revealed CIN incidence was significantly associated with hs-CRP, with 2.4% for quartile Q1 (<6.00 mg/L), 2.3% for Q2 (6.00-13.90), 12.5% for Q3 (13.91-32.75) and 24.4% for Q4 (>32.75) (P-trend <0.001), as was in-hospital death (0% for Q1, 2.3% for Q2, 5% for Q3 and 12.2% for Q4; P-trend = 0.009). Receiver operator characteristic curve analysis showed that an hs-CRP of 16.10 mg/L was a fair discriminator for the early creatinine increase (C statistic 0.78). After adjusting for potential confounding predictors, hs-CRP >16.10 mg/L remained significantly associated with CIN (odds ratio = 6.51; 95% confidence interval, 1.26-33.61).

CONCLUSION

An hs-CRP >16.10 was a significant and independent predictor of CIN after primary PCI in patients with STEMI.