title: Early prediction of acute kidney injury in patients with acute myocardial injury.
abstract: BACKGROUND
  Previous studies have revealed that acute myocardial infarction (AMI) with acute kidney injury (AKI), about 17%, is strongly related to long-term mortality and heart failure. The dynamic changes in renal function during AMI are strongly related to long-term mortality and heart failure.
  
  
  OBJECTIVE
  Our study used clinical parameters and AKI biomarkers including neutrophil gelatinase-associated lipocalin, interleukin (IL)-6, IL-18, and cystatin C to evaluate prognostic relevance of AKI in the setting of AMI.
  
  
  METHODS
  This prospective study was conducted from November 2009 to January 2011 and enrolled sequential 96 patients with catheter-proven AMI; it was approved by the institutional review board of Chang Gung Memorial Hospital, Taiwan (institutional review board no. 99-0140B) and conformed to the tenets of the Declaration of Helsinki. The definition of AKI is the elevation of serum creatinine of more than 0.3 mg/dL within 48 hours.
  
  
  RESULTS
  Our results show that the incidence of AKI after AMI is 17.7% (17 patients). The following could be statistically related to AKI after AMI: age (P = .012), cardiac functions (Killip stage and echocardiogram; P = .003 each), Thrombolysis in Myocardial Infarction (TIMI) flow grade (P < .001), stenting (P < .001), neutrophil gelatinase-associated lipocalin (P = .005), IL-6 (P = .01), IL-18 (P = .002), and cystatin C (P = .002) in serum. The TIMI flow grade and serum cystatin C were shown to be important predictors by using multivariate analysis. Both TIMI flow lower than grade 2 and serum cystatin C of more than 1364 mg/L could be used to predict AKI (both overall correctness, 0.78). Moreover, IL-6 in serum is also associated with the major cardiovascular events after AMI (P = .02), as demonstrated in our study.
  
  
  CONCLUSIONS
  In conclusion, the worse TIMI flow and high plasma cystatin C can be used to predict AKI after AMI. Moreover, IL-6 can also be used as a 30-day major cardiovascular event indicator after AMI. A larger prospective and longitudinal study should follow the relationship between AKI predictors after AMI.
authors: The Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei 105, Taiwan.
authors: Ping-Gune
authors: PG
authors: Hsiao
authors: Chien-An
authors: CA
authors: Hsieh
authors: Chun-Fu
authors: CF
authors: Yeh
authors: Hsueh-Hua
authors: HH
authors: Wu
authors: Tzu-Fang
authors: TF
authors: Shiu
authors: Yung-Chang
authors: YC
authors: Chen
authors: Pao-Hsien
authors: PH
authors: Chu
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology; D000209:Acute-Phase Proteins; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000032:analysis*; D055316:Cystatin C / Q000097:blood; D005260:Female; D006801:Humans; D020382:Interleukin-18 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000652:urine*; D011379:Prognosis; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; D020382:Interleukin-18; D015850:Interleukin-6; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins