title: Association of serum bilirubin with contrast-induced nephropathy and future cardiovascular events in patients undergoing coronary intervention.
abstract: OBJECTIVE
  Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention.
  
  
  METHODS
  Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke.
  
  
  RESULTS
  Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25-43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05-4.90).
  
  
  CONCLUSIONS
  CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.
authors.affiliation: Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shao-Sung
authors.initials: SS
authors.lastname: Huang
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Huang
authors.forename: Tao-Cheng
authors.initials: TC
authors.lastname: Wu
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003287:Contrast Media / Q000009:adverse effects*; D017023:Coronary Angiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D003287:Contrast Media; D001663:Bilirubin