High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study.

Abstract

Background. Accumulating evidence suggests that inflammation plays a key role in acute kidney injury (AKI) pathogenesis. We explored the relationship between high-sensitivity C-reactive protein (hs-CRP) and AKI in acute myocardial infarction (AMI). Methods. We prospectively included 2,063 AMI patients in whom hs-CRP was measured at admission. AKI incidence and a clinical composite of in-hospital death, cardiogenic shock, and acute pulmonary edema were the study endpoints. Results. Two-hundred-thirty-four (11%) patients developed AKI. hs-CRP levels were higher in AKI patients (45 ± 87 vs. 16 ± 41 mg/L; p < 0.0001). The incidence and severity of AKI, as well as the rate of the composite endpoint, increased in parallel with hs-CRP quartiles (p for trend <0.0001 for all comparisons). A significant correlation was found between hs-CRP and the maximal increase of serum creatinine (R = 0.23; p < 0.0001). The AUC of hs-CRP for AKI prediction was 0.69 (p < 0.001). At reclassification analysis, addition of hs-CRP allowed to properly reclassify 14% of patients when added to creatinine and 8% of patients when added to a clinical model. Conclusions. In AMI, admission hs-CRP is closely associated with AKI development and severity, and with in-hospital outcomes. Future research should focus on whether prophylactic renal strategies in patients with high hs-CRP might prevent AKI and improve outcome.

• Authors: Nicola Cosentino, Stefano Genovese, Jeness Campodonico, Alice Bonomi, Claudia Lucci, Valentina Milazzo, Marco Moltrasio, Maria Luisa Biondi, Daniela Riggio, Fabrizio Veglia, Roberto Ceriani, Katia Celentano, Monica De Metrio, Mara Rubino, Antonio L Bartorelli, Giancarlo Marenzi
• Journal: Journal of clinical medicine (J Clin Med) Vol. 8 Issue 12 (Dec 12 2019) ISSN: 2077-0383 [Print] Switzerland
• PMID: 31842300 (Publication Type: Journal Article)