Urinary Biomarkers may Complement the Cleveland Score for Prediction of Adverse Kidney Events After Cardiac Surgery: A Pilot Study

Christian Albert,Michael Haase,Annemarie Albert,Siegfried Kropf,Rinaldo Bellomo,Sabine Westphal,Mark Westerman,Rüdiger Christian Braun-Dullaeus,Anja Haase-Fielitz 대한진단검사의학회 2020 Annals of Laboratory Medicine Vol.40 No.2

Background: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. Methods: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. Results: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01–1.14]), Interleukin-6 (1.51 [1.01–2.26]), midkine (1.01 [1.00–1.02]), 1-hepcidin-25 (1.08 [1.00–1.17]), and NGAL/hepcidin-ratio (2.91 [1.30–6.49]) were independent predictors of MAKE and AKI (1.38 [1.03–1.85], 1.08 [1.01–1.15], 1.01 [1.00–1.02], 1.09 [1.01–1.18], and 3.45 [1.54–7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. Conclusions: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The com

Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients

( Mi Jung Lee ),( Young Eun Kwon ),( Kyoung Sook Park ),( Jung Tak Park ),( Seung Hyeok Han ),( Shin-wook Kang ),( Hyung Jong Kim ),( Tae-hyun Yoo ) 대한신장학회 2017 Kidney Research and Clinical Practice Vol.36 No.4

Background: Geriatric nutritional risk index (GNRI) is a validated nutritional assessment method, and lower GNRI values are closely associated with adverse clinical outcomes in dialysis patients. This study investigated the impact of changes in GNRI during the first year of dialysis on cardiovascular outcomes in incident peritoneal dialysis (PD) patients. Methods: We reviewed medical records in 133 incident PD patients to determine GNRI at the start of PD and after 12 months. Patients were categorized into improved (delta GNRI > 0) and worsening/stationary (delta GNRI ≤ 0) groups. The primary outcome was major adverse cardiac and cerebrovascular events (MACCEs). Results: During a mean follow-up of 51.1 months, the primary outcome was observed in 42 patients (31.6%). The baseline GNRI at PD initiation was not significantly associated with MACCEs (log-rank test, P = 0.40). However, the cumulative event-free rate was significantly lower in the worsening or stationary GNRI group than in the improved group (log-rank test, P = 0.004). Multivariate Cox analysis revealed that a worsening or stationary GNRI was independently associated with higher risk for MACCEs (hazard ratio, 2.47; 95% confidence interval, 1.15-5.29; P = 0.02). In subgroup analysis, patients with worsening or stationary GNRI were at significantly greater risk for MACCEs in both the lower (P = 0.04) and higher (P = 0.01) baseline GNRI groups. Conclusion: Baseline GNRI was not associated with MACCEs, but patients with deteriorating or stationary nutritional status were at significantly greater risk for MACCEs, suggesting that serial monitoring of nutritional status is important to stratify cardiovascular risk in incident PD patients.

관상동맥 스텐트 삽입술 후 Clopidogrel과 Cilostazol의 비교

송인숙,최승기,오정미 한국임상약학회 2005 한국임상약학회지 Vol.15 No.2

Following intracoronary stenting, antiplatelet therapy lead to greater protection from thrombotic complication. A few data are available about the effect of clopidogrel versus cilostazol, an antiplatelet commonly used after intracoronary stenting. To evaluate the efficacy and safety of clopidogrel plus aspirin compared with those of cilostazol plus aspirin in coronary stenting and to evaluate the efficacy of clopidogrel loading dose prior to coronary stealing in clopidogrel group. Data were retrospectively collected from medical charts of patients who had undergone coronary stenting and received either clopidogrel with or without loading 300 mg followed by 75 mg/d (n=58), or 200 mg/d cilostazol(n=72) for 1 year, between January 2000 and May 2002. All patients in both groups received aspirin 200 mg/d throughout the study. The primary endpoints at 7, 30, 180 and 365 days after stealing were the composite of death, Myocardial Infarction, stroke, angina, and revascularization in the intent to treat population and restenosis at follow up angiography. The secondary endpoints were the incidence of bleeding complications at 7, 30, and 365 days, and durg adverse effects at 365 days after stenting. At 180 and 365 days after stenting, the combined primary endpoints were significantly reduced in clopidogrel plus aspirin group (relative risk 0.39; 95% CI 0.17 to 0.92; p=0.021, RR 0.43; 95% CI 0.22 to 0.84; p=0.0085, respectively). However, the combined primary endpoints were not significantly different between the two groups at 7 and 30 days (p:1.00, p=0.79, respectively). Angiographic restenosis rate was 14.3% in clopidogrel plus aspirin uoup and 32.1% in cilostazol plus aspirin group (p=0.19). 300mg of clopidogrel loading dose did not significantly reduce the combined primary endpoints at 30 days after stenting (RR 0.14; 95% CI 0.01 to 2.65; p=0.23). The rate of bleeding complications and drug adverse effects were not different between the two groups. In patients undergoing intracoronary stenting, clopidogrel plus aspirin therapy is more beneficial than cilostazol plus aspirin in reducing major adverse cardiac events with similar rate of bleeding complication. A loading dose of clopidogrel did not lead to a statistically significant reduction in major adverse cardiac events.

관상동맥질환자의 위험인자 군집유형이 부정적 임상예후에 미치는 영향: 이차분석 연구

엄인애,황선영 한국성인간호학회 2020 성인간호학회지 Vol.32 No.2

Purpose: Identify the cluster-type risk factors when disease occurs in patients with coronary artery disease (CAD) and examine the impact of the cluster-type on adverse clinical prognosis in CAD patients. Methods: Secondary data analysis was utilized with data collected from electronic medical records of patients who underwent percutaneous coronary intervention in a university hospital from 2011 to 2015 and who were on an outpatient follow-up visit as of January 2020. The K-means cluster analysis was performed on seven cardiovascular risk factors. Major adverse cardiac events (MACEs), including hospitalization due to restenosis or cardiac-related death, was required in clinical prognosis. The Cox proportional-hazard regression and Kaplan-Meier survival analyses were used. Results: Cluster analysis identified three clusters of ‘obesity and family history’ (n=150), ‘smoking and drinking’ (n=178), and ‘chronic disease’ (n=190). The MACEs occurred in 10.4% of study subjects. When the ‘obesity and family history’ cluster (62.94±12.09 years) was used as a reference, the relative risk of MACEs was 2.57 times higher in the ‘smoking and drinking’ cluster (62.63±13.31 years) and 2.41 times higher in the ‘chronic disease’ cluster (70.90±10.30 years). Conclusion: Cluster-type risk factors are necessary when considering secondary prevention strategies for MACEs in patients with CAD. Patients with smoking, drinking, and chronic diseases are especially required to improve their lifestyles and to regularly monitor their management of underlying diseases during follow-up periods.

The CHA₂DS₂VASc score can be used to stratify the prognosis of acute myocardial infarction patients irrespective of presence of atrial fibrillation

Other Korean Working Group in Myocardial Infarction Registry Investigators,Kim, K.H.,Kim, W.,Hwang, S.H.,Kang, W.Y.,Cho, S.C.,Kim, W.,Jeong, M.H. Japanese College of Cardiology 2015 Journal of cardiology Vol.65 No.2

Background: The CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score has been used to evaluate the risk of thromboembolic events in atrial fibrillation. However, because all the components of CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc are important cardiovascular risk factors, we decided to evaluate the effectiveness of CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score as a long-term predictor for prognosis in acute myocardial infarction (AMI) patients. Methods: We enrolled 15,681 AMI patients for the Korean Working Group in Acute Myocardial Infarction (KORMI) consecutively and analyzed retrospectively. We divided the all the patients into four groups according to CHADS<SUB>2</SUB>VASc score (Group I: 0-1, n=3317; Group II: 2-3, n=6794; Group III: 4-5, n=4457; Group IV: 6-9, n=1113). The cardiac event was defined as the sum of all-cause mortality and recurrence of myocardial infarction. Results: As the risk score increased, the incidence of cardiac events was higher at 1, 6, 12, and 24 months. The cardiac event-free survival rate was lower as the risk score increased (Group I vs Group II, p<0.001; Group II vs Group III, p<0.001; Group III vs Group IV, p=0.037). After adjusting confounding variables, the Cox-regression multivariate analysis showed that the CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score was an independent predictor for the long-term prognosis in total AMI patients (p<0.001, hazard ratio=1.414 per scale). Conclusion: The AMI patients with higher CHA<SUB>2</SUB>DS<SUB>2</SUB>VASc score had worse cardiovascular outcome. Therefore, CHADS<SUB>2</SUB>VASc score can be used to stratify AMI patients according to long-term prognosis irrespective of presence of atrial fibrillation.

Prognostic role of NT-proBNP (N-terminal pro-brain natriuretic peptide) in patients with non-ST-segment elevation myocardial infarction: analysis based on propensity score matching and weighting

Ho Sun Shon,Jang Whan Bae,Kyoung Ok Kim,Eun Jong Cha,Kyung Ah Kim 충북대학교 동물의학연구소 2017 Journal of Biomedical and Translational Research Vol.18 No.3

Recently, N-terminal pro-brain natriuretic peptide (NTproBNP) has been widely used in the areas of diagnosis, monitoring treatment efficiency, and prognosis for various heart diseases, especially heart failure (HF). In this paper, we try to estimate the prognostic significance of NT-proBNP as a risk evaluation marker in Non-ST-segment Elevation Myocardial Infarction (NSTEMI) patients. We selected NSTEMI patients who underwent percutaneous coronary intervention (PCI) primarily using a drug-eluting stent within 24 h after the onset of chest pain. We compared incidences of major adverse cardiac events (MACE) including death, myocardial infarction (MI), stent thrombosis (ST), and target vessel revascularization (TVR) in two patient groups according to a high or low serum concentration of NT-proBNP, which was measured in the emergency room (ER). We intend to minimize selection bias selecting comparing groups, considering covariate of observed variables together using propensity score matching (PSM) and propensity score weighting (PSW) based on propensity score (PS) to control the difference in baseline characteristics between high- and low NT-proBNP groups. We found that as the log NT-proBNP value increases by 1 through a hazard function of COX’s analysis, the risk of MACE increases by 1.312 times. This result indicated that the NT-proBNP level on ER admission can be used as a significant prognostic indicator to estimate 1 year of MACE in NSTEMI patients who were treated with PCI within 24 h after the onset of chest pain.

Absolute change in fasting plasma glucose over 12months is associated with 2-year and 5-year major adverse cardiovascular events in patients with drug-eluting stent implants

Kang, D.O.,Seo, H.S.,Choi, B.G.,Lee, E.,Kim, J.P.,Lee, S.K.,Im, S.I.,Na, J.O.,Choi, C.U.,Lim, H.E.,Kim, J.W.,Kim, E.J.,Rha, S.W.,Park, C.G.,Oh, D.J. Elsevier/North-Holland Biomedical Press 2015 INTERNATIONAL JOURNAL OF CARDIOLOGY Vol.179 No.-

Background: Major adverse cardiovascular events (MACEs) in patients with or without cardiovascular disease (CVD) are greatly affected by various factors associated with metabolism and inflammation. Objective: To determine which clinical parameters at treatment are associated with the development of 2-year and 5-year MACEs in high-risk patients with CVD who have undergone drug-eluting stent (DES) implantation. Method: The present study involved a total of 432 patients who underwent percutaneous coronary intervention with DES. Variables representing the average and absolute amount of change in clinical parameters over the 12-month follow-up were assessed for association with 2-year and 5-year development of MACE. The study population was divided into quartiles for the variable showing the highest correlation to MACE development. Estimated incidence of 2-year and 5-year MACEs for each of the quartiles was determined by survival curve analysis, and subgroup analysis was performed for patients with diabetes and statin users. Results: Absolute change in fasting plasma glucose (FPG) over 12months showed the highest correlation with 2-year and 5-year MACE development. The estimated incidence of MACE increased with increasing quartiles for absolute change in FPG. The association between absolute change in FPG and MACE development exhibited a stronger relationship for the specific subgroups of patients with diabetes and statin users. Increases and decreases in FPG had a comparable contribution to MACE development. Conclusion: A greater absolute change in FPG over 12months post-PCI is an independent risk factor for 2-year and 5-year MACE development in DES-implanted patients, especially in the diabetes and statin users.

Serum Copeptin Levels Predict Clinical Outcomes After Successful Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction

최현정,김민철,심두선,홍영준,김주한,정명호,김수현,신명근,안영근 대한진단검사의학회 2018 Annals of Laboratory Medicine Vol.38 No.6

Background: Serum copeptin has been demonstrated to be useful in early risk stratification and prognostication of patients with acute myocardial infarction (AMI). However, the prognostic value of copeptin after percutaneous coronary intervention (PCI) for clinical outcomes remains uncertain. We investigated the prognostic role of serum copeptin levels immediately after successful PCI as a prognostic marker for major adverse cardiac events (MACE; comprising death, repeat PCI, recurrent MI, or coronary artery bypass grafting) in patients with AMI. Methods: A retrospective study was performed in 149 patients with AMI who successfully received PCI. Serum copeptin levels were analyzed in blood samples collected immediately after PCI. The association between copeptin levels and MACE during the follow-up period was evaluated. Results: MACE occurred in 34 (22.8%) patients during a median follow-up of 30.1 months. MACE patients had higher copeptin levels than non-MACE patients did. Multiple logistic regression analysis showed that the increase in serum copeptin levels was associated with increased MACE incidence (odds ratio=1.6, P=0.005). Conclusions: A high level of serum copeptin measured immediately after PCI was associated with MACE in patients with AMI during long-term follow-up. Serum copeptin levels can serve as a prognostic marker in patients with AMI after successful PCI.

스텐트 내 재협착 병변에서 약물용출 풍선확장술 후 주요 심장사건 발생의 예측인자

이두환(Doo Hwan Lee),김인수(In Soo Kim),공창기(Chang gi Kong),한재복(Jae Bok Han) 한국방사선학회 2020 한국방사선학회 논문지 Vol.14 No.2

이 연구는 스텐트 내 재협착 병변에서 약물용출 풍선 확장술을 시행한 환자를 대상으로 주요 심장사건에 영향을 미치는 예측 인자가 무엇인지 알아보고자 하였다. 2012년 10월부터 2017년 1월까지 전남대학교병원 심혈관센터에서 경피적 관상동맥 삽입술 후 스텐트 내 재협착이 발생한 환자 중에서 약물용출 풍선 확장술을 시행 받은 환자 257명 (평균연령 66.1±10.1세, 남자 172명)을 대상으로 그룹 I (주요 심장사건 발생군, n=35명), 그룹 II (주요 심장사건 발생하지 않은 군, n=222명)로 나누어 분류 하였다. 약물용출 풍선 성형술 후 주요 심장사건의 독립적인 예측 인자를 보기 위한 다변량 분석에서 완전 폐쇄병변 형태의 재협착 형태 (HR=4.179, 95% C.I.=1.851-9.437 p= 0.001), 25 mm이상의 긴 병변 (HR=8.773, 95% C.I.=1.898-40.546 p= 0.005), 반복되는 스텐트 내 재협착 (HR=4.693, 95% C.I.=1.259-17.490 p= 0.021)이 독립적인 예측 인자로 판명되었다. The aim of this study was to investigate the predictors of major adverse cardiac events (MACE) in patients with drug-eluting balloon (DEB) for in-stent restenosis (ISR) lesion. Total of 257 patients who developed ISR on follow-up coronary angiography (66.1 ± 10.1years, 172 males) in Chonnam National University Hospital between October 2012 and January 2017 were enrolled. We divided the patients into two groups; group I (MACE group; n= 35) and group II (No MACE group; n= 222). A multivariate logistic regression analysis revealed that type IV ISR (HR=4.179, 95% C.I.=1.851-9.437 p= 0.001), lesion length > 25 mm (HR=8.773, 95% C.I.=1.898-40.546 p= 0.005), number of ISR recurrence > 2 (HR=4.693, 95% C.I.=1.259-17.490 p= 0.021) were independent factors for MACE after DEB in ISR lesions.

Predictive Value of Plasma NGAL:Hepcidin-25 for Major Adverse Kidney Events After Cardiac Surgery with Cardiopulmonary Bypass: A Pilot Study

Albert Christian,Haase Michael,Albert Annemarie,Ernst Martin,Kropf Siegfried,Bellomo Rinaldo,Westphal Sabine,Braun-Dullaeus Rüdiger C.,Haase-Fielitz Anja,Elitok Saban 대한진단검사의학회 2021 Annals of Laboratory Medicine Vol.41 No.4

Background: Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin-25 are involved in catalytic iron-related kidney injury after cardiac surgery with cardiopulmonary bypass. We explored the predictive value of plasma NGAL, plasma hepcidin-25, and the plasma NGAL:hepcidin-25 ratio for major adverse kidney events (MAKE) after cardiac surgery. Methods: We compared the predictive value of plasma NGAL, hepcidin-25, and plasma NGAL:hepcidin-25 with that of serum creatinine (Cr) and urinary output and protein for primary-endpoint MAKE (acute kidney injury [AKI] stages 2 and 3, persistent AKI >48 hours, acute dialysis, and in-hospital mortality) and secondary-endpoint AKI in 100 cardiac surgery patients at intensive care unit (ICU) admission. We performed ROC curve, logistic regression, and reclassification analyses. Results: At ICU admission, plasma NGAL, plasma NGAL:hepcidin-25, plasma interleukin-6, and Cr predicted MAKE (area under the ROC curve [AUC]: 0.77, 0.79, 0.74, and 0.74, respectively) and AKI (0.73, 0.89, 0.70, and 0.69). For AKI prediction, plasma NGAL:hepcidin-25 had a higher discriminatory power than Cr (AUC difference 0.26 [95% CI 0.00–0.53]). Urinary output and protein, plasma lactate, C-reactive protein, creatine kinase myocardial band, and brain natriuretic peptide did not predict MAKE or AKI (AUC <0.70). Only plasma NGAL:hepcidin-25 correctly reclassified patients according to their MAKE and AKI status (category-free net reclassification improvement: 0.82 [95% CI 0.12–1.52], 1.03 [0.29–1.77]). After adjustment to the Cleveland risk score, plasma NGAL:hepcidin-25 ≥0.9 independently predicted MAKE (adjusted odds ratio 16.34 [95% CI 1.77–150.49], P=0.014). Conclusions: Plasma NGAL:hepcidin-25 is a promising marker for predicting postoperative MAKE.