Contrast-induced nephropathy (CIN) significantly increases morbidity and mortality among acute myocardial infarction (MI) patients undergoing coronary angiography (CAG). This study evaluated the predictive value of serum uric acid (SUA) and C-reactive protein/albumin ratio (CAR) for CIN development. A retrospective analysis included 1326 acute MI patients who underwent CAG between November 2022 and January 2024. CIN occurred in 119 patients (9.0%). Higher SUA (5.60 vs 4.60 mg/dL, P < .001) and CAR (2.79 vs 2.15, P = .004) were significantly associated with CIN. Multivariate analysis confirmed SUA (Odds Ratio [OR]: 1.577, P < .001) and contrast volume (OR: 1.014, P < .001) as independent predictors. Receiver Operating Characteristic (ROC) analysis identified optimal SUA cutoff at 4.9 mg/dL (sensitivity 67.7%, specificity 68.1%). The predictive value of SUA was stronger among diabetic patients. Additionally, SUA positively correlated with CAR (r = .41, P < .001). A simplified risk score incorporating SUA, CAR, contrast volume, diabetes, and age effectively stratified CIN risk. Elevated SUA levels and high CAR independently predict CIN in acute MI patients, enhancing clinical risk stratification and guiding preventive strategies.
RudnickMRKesselheimAGoldfarbS.Contrast-induced nephropathy: how it develops, how to prevent it. Cleve Clin J Med. 2006;73(1):75-80, 83-87.
5.
PisaniARiccioEAndreucciM, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy. Biomed Res Int. 2013;2013:868321.
6.
GoldenbergIMatetzkyS.Nephropathy induced by contrast media: pathogenesis, risk factors and preventive strategies. CMAJ. 2005;172(11):1461-1471.
7.
ZuoTJiangLMaoSLiuXYinXGuoL.Hyperuricemia and contrast-induced acute kidney injury: a systematic review and meta-analysis. Int J Cardiol. 2016;224:286-294.
8.
KanbayMSolakYAfsarB, et al. Serum uric acid and risk for acute kidney injury following contrast. Angiology. 2017;68(2):132-144.
9.
MercuroGVitaleCCerquetaniE, et al. Effect of hyperuricemia upon endothelial function in patients at increased cardiovascular risk. Am J Cardiol. 2004;94(7):932-935.
10.
RuggieroCCherubiniAMillerE, et al. Usefulness of uric acid to predict changes in C-reactive protein and interleukin-6 in 3-year period in Italians aged 21 to 98 years. Am J Cardiol. 2007;100(1):115-121.
11.
LiuYTanNZhouYL, et al. High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol. 2012;25(3):332-340.
12.
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):683-690.
13.
KayaAKayaYTopçuS, et al. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65(1):51-56.
14.
HuangJZhangQWangR, et al. Systemic immune-inflammatory index predicts clinical outcomes for elderly patients with acute myocardial infarction receiving percutaneous coronary intervention. Med Sci Monit. 2019;25:9690-9701.
15.
YangYLWuCHHsuPF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230.
16.
KelesogluSYilmazYElcikD, et al. C-reactive protein to albumin ratio as a predictor of contrast-induced nephropathy after carotid angiography. Angiology. 2024;75(1):90-97.
17.
StaculFvan der MolenAJReimerP, et al. Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol. 2011;21(12):2527-2541.
18.
RencuzogullariIÇağdaşMKarakoyunS, 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.
19.
WangJZhangCLiuZBaiY.Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis. J Int Med Res. 2021;49(4):3000605211005972.
20.
De LucaGSuryapranataHMarinoP. Reperfusion strategies in acute ST-elevation myocardial infarction: an overview of current status. Prog Cardiovasc Dis. 2008;50(5):352-382.
21.
McCulloughPASomanSS.Contrast-induced nephropathy. Crit Care Clin. 2005;21(2):261-280.
22.
MarguliesKSchirgerJBurnettJJr.Radiocontrast-induced nephropathy: current status and future prospects. Int Angiol. 1992;11(1):20-25.
23.
MarenziGDe MetrioMRubinoM, et al. Acute hyperglycemia and contrast-induced nephropathy in primary percutaneous coronary intervention. Am Heart J. 2010;160(6):1170-1177.
24.
MaiuoloJOppedisanoFGratteriSMuscoliCMollaceV.Regulation of uric acid metabolism and excretion. Int J Cardiol. 2016;213:8-14.
KanbayAInonuHSolakY, et al. Uric acid as a potential mediator of cardiovascular morbidity in obstructive sleep apnea syndrome. Eur J Intern Med. 2014;25(5):471-476.
27.
EkiciBKütükUAlhanATöreHF.The relationship between serum uric acid levels and angiographic severity of coronary heart disease. Kardiol Pol. 2015;73(7):533-538.
28.
MudgeGH.Uricosuric action of cholecystographic agents. A possible factor in nephrotoxicity. N Engl J Med. 1971;284(17):929-933.
29.
JungYDFanFMcConkeyDJ, et al. Role of P38 MAPK, AP-1, and NF-κB in interleukin-1β-induced IL-8 expression in human vascular smooth muscle cells. Cytokine. 2002;18(4):206-213.
30.
CorryDBEslamiPYamamotoKNybyMDMakinoHTuckML.Uric acid stimulates vascular smooth muscle cell proliferation and oxidative stress via the vascular renin-angiotensin system. J Hypertens. 2008;26(2):269-275.
31.
FiliopoulosVHadjiyannakosDVlassopoulosD.New insights into uric acid effects on the progression and prognosis of chronic kidney disease. Ren Fail. 2012;34(4):510-520.
32.
BarbieriLVerdoiaMSchafferA, et al. Uric acid levels and the risk of contrast induced nephropathy in patients undergoing coronary angiography or PCI. Nutr Metab Cardiovasc Dis. 2015;25(2):181-186.
33.
ShachamYGal-OzAFlintNKerenGArbelY.Serum uric acid levels and renal impairment among ST-segment elevation myocardial infarction patients undergoing primary percutaneous intervention. Cardiorenal Med. 2016;6(3):191-197.
34.
MendiMAAfsarBOksuzF, et al. Uric Acid is a useful tool to predict contrast-induced nephropathy. Angiology. 2017;68(7):627-632.
35.
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):1393-1399.
36.
ErolTTekinAKatırcıbaşıMT, et al. Efficacy of allopurinol pretreatment for prevention of contrast-induced nephropathy: a randomized controlled trial. Int J Cardiol. 2013;167(4):1396-1399.
37.
ToprakO.Risk markers for contrast-induced nephropathy. Am J Med Sci. 2007;334(4):283-290.
38.
GucunMAkyuzOBayramECakmakEO.Systemic immune-inflammation index is a novel marker to predict contrast-induced acute kidney injury. Eurasian J Med Investig. 2021;5(4):435-440.
39.
KelesogluSYilmazYElcıkD, et al. Systemic immune inflammation index: a novel predictor of contrast-induced nephropathy in patients with non-ST segment elevation myocardial infarction. Angiology. 2021;72(9):889-895.
40.
KanWCHuangYTWuVCShiaoCC.Predictive ability of procalcitonin for acute kidney injury: a narrative review focusing on the interference of infection. Int J Mol Sci. 2021;22(13):6903.
41.
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):366-371.
42.
KarabağYÇağdaşMRencuzogullariI, et al. 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):1638-1645.
43.
ToprakOCiritMYesilM, et al. Impact of diabetic and pre-diabetic state on development of contrast-induced nephropathy in patients with chronic kidney disease. Nephrol Dial Transplant. 2007;22(3):819-826.
44.
ÇetinMAcehanFKundiH, et al. A novel risk prediction tool for contrast-induced nephropathy in patients with chronic kidney disease who underwent diagnostic coronary angiography. Eur Rev Med Pharmacol Sci. 2023;27(8):3430-3437.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
