Inflammatory Indicators and Hematological Indices in Contrast-Induced Nephropathy Among Patients Receiving Coronary Intervention: A Systematic Review and Meta-Analysis
Restricted accessResearch articleFirst published online October, 2021
Inflammatory Indicators and Hematological Indices in Contrast-Induced Nephropathy Among Patients Receiving Coronary Intervention: A Systematic Review and Meta-Analysis
Strong inflammatory indicators such as C-reactive protein (CRP), high-sensitivity CRP (hsCRP), and hematological indices, including platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), hematocrit (HCT), and red blood cell distribution width (RDW), may be related with contrast-induced nephropathy (CIN). Our meta-analysis aimed at exploring the relationship between these indicators and CIN incidence among patients undergoing coronary intervention. Clinical studies were retrieved from the electronic databases of PubMed, EMBASE, Google Scholar, Clinical Trials, and Science Direct from their inception to June 3, 2020. Meta-analysis was performed on pooled eligible studies. Finally, 26 studies involving 29 454 patients were included. Pooled analysis revealed that patients with higher CRP (odds ratio [OR] = 1.06, 95% CI: 1.01-1.12, P = .02), hsCRP (OR = 1.03, 95% CI: 1.01-1.06, P = .004), NLR (OR = 1.11, 95% CI: 1.01-1.20, P = .02), RDW (OR = 1.35, 95% CI: 1.19-1.53, P < .001), and lower HCT (OR = 0.94, 95% CI: 0.92-0.97, P = .003) all exhibited significantly higher CIN rates, but there was no significant association between PLR and CIN risk (OR = 1.12, 95% CI: 0.99-1.26, P = .07). Pre-angiography CRP/hsCRP and some hematological indices are associated with CIN.
McCulloughPASandbergKR. Epidemiology of contrast-induced nephropathy. Rev Cardiovasc Med. 2003;4suppl 5:S3–S9.
2.
UlusTIsgandarovKYilmazAS, et al.Monocyte to High-Density Lipoprotein Ratio Predicts Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome. Angiology. 2018;69(10):909–16.
3.
OnkDOnkOATurkmenK, et al.Melatonin Attenuates Contrast-Induced Nephropathy in Diabetic Rats: The Role of Interleukin-33 and Oxidative Stress. Mediators Inflamm. 2016;2016:9050828.
4.
KwasaEAVinayakSArmstrongR. The role of inflammation in contrast-induced nephropathy. Br J Radiol. 2014;87(1041):20130738.
5.
ZhaoQYinJLuZ, et al.Sulodexide Protects Contrast-Induced Nephropathy in Sprague-Dawley Rats. Cell Physiol Biochem. 2016;40(3-4):621–32.
6.
LuZChengDYinJ, et al.Antithrombin III Protects Against Contrast-Induced Nephropathy. Ebiomedicine. 2017;17:101–7.
7.
ZhaoBZhaoQLiJXingTWangFWangN. Renalase protects against contrast-induced nephropathy in Sprague-Dawley rats. Plos One. 2015;10(1):e116583.
8.
BibekSBXieYGaoJJWangZWangJFGengDF. Role of pre-procedural C-reactive protein level in the prediction of major adverse cardiac events in patients undergoing percutaneous coronary intervention: a meta-analysis of longitudinal studies. Inflammation. 2015;38(1):159–69.
9.
ChoKIAnnSHSinghGBHerAYShinES. Combined Usefulness of the Platelet-to-Lymphocyte Ratio and the Neutrophil-to-Lymphocyte Ratio in Predicting the Long-Term Adverse Events in Patients Who Have Undergone Percutaneous Coronary Intervention with a Drug-Eluting Stent. Plos One. 2015;10(7):e133934.
10.
VakiliHShiraziMCharkhkarMKhaheshiIMemaryanMNaderianM. Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction. Eur J Clin Invest. 2017;47(4):322–7.
11.
ZhangSDiaoJQiC, et al.Predictive value of neutrophil to lymphocyte ratio in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention: a meta-analysis. BMC Cardiovasc Disord. 2018;18(1):75.
12.
MaluendaGLemesleGCollinsSD, et al.The clinical significance of hematocrit values before and after percutaneous coronary intervention. Am Heart J. 2009;158(6):1024–30.
13.
ChangXWZhangSYWangH, et al.Combined value of red blood cell distribution width and global registry of acute coronary events risk score on predicting long-term major adverse cardiac events in STEMI patients undergoing primary PCI. Oncotarget. 2018;9(17):13971–80.
14.
BozorgiAKhakiSMortazaviSH, et al.Effect of Baseline Red Blood Cell Distribution Width on Short- and Intermediate-term Mortality of Patients Under Primary Percutaneous Coronary Intervention: A Survival Analysis. Crit Pathw Cardiol. 2016;15(2):69–74.
15.
CotaGFde SousaMRFereguettiTORabelloA. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis. 2013;7(5):e2195.
16.
FuXZhouQZhangX.Efficacy Comparison Between Total Laryngectomy and Nonsurgical Organ-Preservation Modalities in Treatment of Advanced Stage Laryngeal Cancer: A Meta-Analysis. Medicine (Baltimore). 2016;95(14):e3142.
17.
PrictorMHillS. Cochrane Consumers and Communication Review Group: leading the field on health communication evidence. J Evid Based Med. 2013;6(4):216–20.
18.
ChoJYMJeongMHMPHwan ParkSM, et al.Effect of contrast-induced nephropathy on cardiac outcomes after use of nonionic isosmolar contrast media during coronary procedure. J Cardiol. 2010;56(3):300–6.
19.
DangasGIakovouINikolskyE, et al.Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol. 2005;95(1):13–9.
20.
DemircelikMBKurtulAOcekHCakmakMUreyenCEryonucuB. Association between Platelet-to-Lymphocyte Ratio and Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. Cardiorenal Med. 2015;5(2):96–104.
21.
ElhosseinySAkelTMroueJTathineniPEl SayeghSLaffertyJ. The Value of Adding Red Cell Distribution Width to Mehran Risk Score to Predict Contrast-induced Acute Kidney Injury in Patients with Acute Coronary Syndrome. Cureus. 2018;10(7):e2911.
22.
EshraghiANaranji-SaniRPourzandH, et al.Pentoxifylline and prevention of contrast-induced nephropathy: Is it efficient in patients with myocardial infarction undergoing coronary angioplasty?ARYA Atheroscler. 2016;12(5):238–42.
23.
EvolaSLunettaMMacaioneF, et al.Risk factors for contrast induced nephropathy: A study among Italian patients. Indian Heart Journal. 2012;64(5):484–91.
24.
GaoFZhouYJZhuXWangZJYangSWShenH. C-reactive protein and the risk of contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention. Am J Nephrol. 2011;34(3):203–10.
25.
GohbaraMHayakawaAAkazawaY, et al.Association Between Acidosis Soon After Reperfusion and Contrast-Induced Nephropathy in Patients With a First-Time ST-Segment Elevation Myocardial Infarction. J Am Heart Assoc. 2017;6(8).
26.
KayaAKayaYTopcuS, et al.Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65(1):51-6.
27.
KocasCYildizAAbaciO, et al.Platelet-to-Lymphocyte Ratio Predicts Contrast-Induced Nephropathy in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Angiology. 2015;66(10):964–8.
28.
KooHMDohFMKoKI, et al.Diastolic dysfunction is associated with an increased risk of contrast-induced nephropathy: a retrospective cohort study. Bmc Nephrol. 2013;14:146.
29.
KurtulAYarliogluesMDuranM. Predictive Value of CHA2DS2-VASC Score for Contrast-Induced Nephropathy After Percutaneous Coronary Intervention for Acute Coronary Syndrome. Am J Cardiol. 2017;119(6):819–25.
30.
KurtulAYarliogluesMMuratSN, et al.Red cell distribution width predicts contrast-induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Angiology. 2015;66(5):433–40.
31.
MizunoAOhdeSNishizakiYKomatsuYNiwaK. Additional value of the red blood cell distribution width to the Mehran risk score for predicting contrast-induced acute kidney injury in patients with ST-elevation acute myocardial infarction. J Cardiol. 2015;66(1):41–5.
32.
NakamuraTSugayaTNodeKUedaYKoideH. Urinary Excretion of Liver-Type Fatty Acid–Binding Protein in Contrast Medium–Induced Nephropathy. Am J Kidney Dis. 2006;47(3):439–44.
33.
OksuzFYarliogluesMCayS, et al.Predictive Value of Gamma-Glutamyl Transferase Levels for Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention. Am J Cardiol. 2015;116(5):711–6.
34.
RencuzogullariICagdasMKarakoyunS, et al.Association of Syntax Score II with Contrast-induced Nephropathy and Hemodialysis Requirement in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Korean Circ J. 2018;48(1):59–70.
35.
SagSYildizAAydinKA, et al.Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI. Clin Chem Lab Med. 2017;55(1):132–8.
36.
SatilmisSKarabulutA. Value of C-Reactive Protein/Albumin Ratio in Predicting the Development of Contrast-Induced Nephropathy in Patients With Non-ST Elevation Myocardial Infarction. Angiology. 2020;71(4):366–71.
37.
SunXPLiJZhuWW, et al.Platelet to Lymphocyte Ratio Predicts Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2018;69(1):71–8.
38.
Yavuz KarabagMCIR. The C-Reactive Protein to Albumin Ratio Predicts Acute Kidney Injury in Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Heart Lung Circ. 2019;28(11):1638–45
39.
YildirimEErmisECengizM. Inflammatory markers of contrast-induced nephropathy in patients with acute coronary syndrome. Coronary Artery Dis. 2020;31(3):279–83.
40.
YuanYQiuHHuX, et al.Predictive value of inflammatory factors on contrast-induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention. Clin Cardiol. 2017;40(9):719–25.
41.
Zbierska-RubinkiewiczKTrębaczOTomalaMRubinkiewiczMChrzanIGackowskiA. Creatine kinase-MB and red cell distribution width as predictors of contrast-induced nephropathy after percutaneous coronary intervention in acute myocardial infarction. Folia medica Cracoviensia. 2017;57(3):87.
42.
ZhaoKLiYGaoQ. Role of red blood cell distribution width in predicting contrast induced nephropathy in patients with stable angina pectoris undergoing percutaneous coronary intervention. Int J Cardiol. 2015;197:276–8.
43.
ZorluCKoseogluC. Comparison of the Relationship Between Inflammatory Markers and Contrast-Induced Nephropathy in Patients With Acute Coronary Syndrome After Coronary Angiography. Angiology. 2020;71(3):249–55.
44.
RidkerPM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation. 2003;107(3):363–9.
45.
TonelliMSacksFPfefferMJhangriGSCurhanG. Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int. 2005;68(1):237–45.
46.
Jian-WeiZYu-JieZShu-JunCQingYShi-WeiYBinN. Impact of preprocedural high-sensitivity C-reactive protein on contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65(5):402–7.
47.
YunKHLimJHHwangKB, et al.Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy. Korean Circ J. 2014;44(5):301–6.
48.
GuoXSLinKYLiHL, et al.Preprocedural High-Sensitivity C-Reactive Protein Predicts Contrast-Induced Nephropathy and Long-Term Outcome After Coronary Angiography. Angiology. 2017;68(7):614–20.
49.
DuanCCaoYLiuY, et al.A New Preprocedure Risk Score for Predicting Contrast-Induced Acute Kidney Injury. Can J Cardiol. 2017;33(6):714–23.
50.
LiuYHLiuYTanN, et al.Predictive value of GRACE risk scores for contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction before undergoing primary percutaneous coronary intervention. Int Urol Nephrol. 2014;46(2):417–26.
51.
LazarosGZografosTOikonomouE, et al.Usefulness of C-Reactive Protein as a Predictor of Contrast-Induced Nephropathy After Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction and Presentation of a New Risk Score (Athens CIN Score). Am J Cardiol. 2016;118(9):1329–33.
52.
TosoALeonciniMMaioliM, et al.Relationship between inflammation and benefits of early high-dose rosuvastatin on contrast-induced nephropathy in patients with acute coronary syndrome: the pathophysiological link in the PRATO-ACS study (Protective Effect of Rosuvastatin and Antiplatelet Therapy on Contrast-Induced Nephropathy and Myocardial Damage in Patients With Acute Coronary Syndrome Undergoing Coronary Intervention). JACC Cardiovasc Interv. 2014;7(12):1421–9.
53.
HanSSKimDKKimSChinHJChaeDWNaKY. C-Reactive Protein Predicts Acute Kidney Injury and Death After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2017;104(3):804–10.
54.
FuELFrankoMAObergfellA, et al.High-sensitivity C-reactive protein and the risk of chronic kidney disease progression or acute kidney injury in post–myocardial infarction patients. Am Heart J. 2019;216:20–9.
55.
TangYHuangXRLvJ, et al.C-reactive protein promotes acute kidney injury by impairing G1/S-dependent tubular epithelium cell regeneration. Clin Sci (Lond). 2014;126(9):645–59.
56.
LaiWTangYHuangXR, et al.C-reactive protein promotes acute kidney injury via Smad3-dependent inhibition of CDK2/cyclin E. Kidney Int. 2016;90(3):610–26.
57.
BianAShiMFloresB, et al.Downregulation of autophagy is associated with severe ischemia-reperfusion-induced acute kidney injury in overexpressing C-reactive protein mice. Plos One. 2017;12(9):e181848.
58.
GaetanoMDe FerrariSCASMarco FerliniSPMF. Platelet to lymphocyte Ratio is an independent Risk Factor of contrast induced nephropathy in patients with st elevation myocardial infarction undergoing primary percutaneous coronary intervention. Poster Contributions Poster Hall B1 Monday, March 16, 2015, 9:45 a.m.-10:30 a.m; 2015.
59.
VelibeyYOzATanikO, et al.Platelet-to-Lymphocyte Ratio Predicts Contrast-Induced Acute Kidney Injury in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology. 2017;68(5):419–27.
60.
TurkmenKErdurFMOzcicekF, et al.Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients. Hemodial Int. 2013;17(3):391–6.
61.
JiangJJiHXieW, et al.Could platelet-to-lymphocyte ratio be a predictor for contrast-induced nephropathy in patients with acute coronary syndrome?Medicine. 2019;98(32):e16801.
62.
ShahNParikhVPatelN, et al.Neutrophil lymphocyte ratio significantly improves the Framingham risk score in prediction of coronary heart disease mortality: insights from the National Health and Nutrition Examination Survey-III. Int J Cardiol. 2014;171(3):390–7.
63.
KurtulAYarliogluesMDuranMMuratSN. Association of Neutrophil-to-lymphocyte Ratio with Contrast-induced Nephropathy in Patients with Non-ST-elevation Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention. Heart Lung Circ. 2016;25(7):683–90.
64.
VuruskanESaracogluE. Bilirubin Levels are Associated With Contrast-Induced Nephropathy in Peripheral Artery Disease. Angiology. 2017;68(8):728–33.
65.
ArganOUralDKozdagG, et al.Associations Between Neutrophil Gelatinase Associated Lipocalin, Neutrophil-to-Lymphocyte Ratio, Atrial Fibrillation and Renal Dysfunction in Chronic Heart Failure. Med Sci Monit. 2016;22:4765–72.
66.
AzabBDaoudJNaeemFB, et al.Neutrophil-to-lymphocyte ratio as a predictor of worsening renal function in diabetic patients (3-year follow-up study). Ren Fail. 2012;34(5):571–6.
67.
MehranRAymongEDNikolskyE, et al.A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393–9.
68.
NikolskyEMehranRLasicZ, et al.Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int. 2005;67(2):706–13.
69.
TonelliMSacksFArnoldMMoyeLDavisBPfefferM. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation. 2008;117(2):163–8.
70.
AkinFKoseNAycaB, et al.Relation between red cell distribution width and severity of coronary artery disease in patients with acute myocardial infarction. Angiology. 2013;64(8):592–6.
71.
DocciDDelvecchioCGolliniCTurciFBaldratiLGilliP. Red blood cell volume distribution width (RDW) in uraemic patients on chronic haemodialysis. Int J Artif Organs. 1989;12(3):170–4.
72.
UjszasziAMolnarMZCziraMENovakMMucsiI. Renal function is independently associated with red cell distribution width in kidney transplant recipients: a potential new auxiliary parameter for the clinical evaluation of patients with chronic kidney disease. Br J Haematol. 2013;161(5):715–25.
73.
Van DriestSLJoosteEHShiY, et al.Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery. Jama Pediatr. 2018;172(7):655–63.
74.
ZouZZhuangYLiuL, et al.Role of elevated red cell distribution width on acute kidney injury patients after cardiac surgery. Bmc Cardiovasc Disor. 2018;18(1):166–7.
