Contrast medium volume to creatinine clearance ratio: A predictor of contrast-induced nephropathy in the first 72 hours following percutaneous coronary intervention

• Published in: Catheterization and cardiovascular interventions Vol. 79; no. 1; pp. 70 - 75
• Main Authors: Tan, Ning, Liu, Yong, Zhou, Ying-Ling, He, Peng-Cheng, Yang, Jun-Qing, Luo, Jian-Fang, Chen, Ji-Yan
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.01.2012
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary; Biomarkers - blood; China; Contrast Media - adverse effects; Contrast Media - pharmacokinetics; contrast medium; contrast-induced nephropathy; Creatinine - blood; creatinine clearance; diabetes; Female; Humans; Kidney Diseases - blood; Kidney Diseases - chemically induced; Kidney Diseases - diagnosis; Kidney Diseases - prevention & control; Logistic Models; Male; Middle Aged; Multivariate Analysis; percutaneous coronary intervention; Predictive Value of Tests; Prospective Studies; Radiography, Interventional - adverse effects; Risk Assessment; Risk Factors; ROC Curve; Sensitivity and Specificity; Time Factors; Treatment Outcome; Up-Regulation; China
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.23048

Objectives: To investigate the predictive value of the contrast media volume to creatinine clearance (V/CrCl) ratio for the risk of contrast‐induced nephropathy (CIN) (i.e., within 48–72 hr) and to determine a relatively safe V/CrCl cut‐off value to avoid CIN in patients following percutaneous coronary intervention (PCI). Background: The V/CrCl ratio is a pharmacokinetic risk factor for an early abnormal increase in serum creatinine (i.e., within 24 hr) after PCI. Methods: V/CrCl ratios were obtained from 1,140 consecutive consenting patients after unselective PCI. Receiver‐operator characteristic (ROC) curves were used to identify the optimal sensitivity for the observed range of V/CrCl. The predictive value of V/CrCl for the risk of CIN was assessed using multivariate logistic regression. Results: Fifty‐five (4.8%) patients out of 1,140 developed CIN. There was a significant association between higher V/CrCl ratio values and risk of CIN in the overall population: 1.4%, 1.4%, 5.7%, and 10.9% for quartile 1 (Q1) of the V/CrCl value (<1.56, n = 283), Q2 (1.56–2.27, n = 289), Q3 (2.28–3.42, n = 282), and Q4 (>3.42, n = 285) of contrast, respectively (P < 0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.62 was a fair discriminator for CIN (C‐statistic 0.73). After adjusting for other known predictors of CIN, V/CrCl ratios > 2.62 remained significantly associated with CIN (odds ratio: 2.20; 95% confidence interval: 1.00–4.81, P < 0.05). Conclusion: A V/CrCl ratio > 2.62 was a significant and independent predictor of CIN after PCI in unselected patients. © 2011 Wiley Periodicals, Inc