B-type natriuretic peptide and risk of acute kidney injury in patients hospitalized with acute coronary syndromes*.
OBJECTIVE
To investigate whether admission B-type natriuretic peptide levels predict the development of acute kidney injury in acute coronary syndromes.


METHODS
Prospective study.


METHODS
Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center.


METHODS
Six-hundred thirty-nine acute coronary syndromes patients undergoing emergency and urgent percutaneous coronary intervention.


METHODS
None.


RESULTS
We measured B-type natriuretic peptide at hospital admission in acute coronary syndromes patients (55% ST-elevation myocardial infarction and 45% non-ST-elevation myocardial infarction). Acute kidney injury was classified according to the Acute Kidney Injury Network criteria: stage 1 was defined as a serum creatinine increase greater than or equal to 0.3 mg/dL from baseline; stage 2 as a serum creatinine increase greater than two- to three-fold from baseline; stage 3 as a serum creatinine increase greater than three-fold from baseline, or greater than or equal to 4.0 mg/dL with an acute increase greater than 0.5 mg/dL, or need for renal replacement therapy. Acute kidney injury was developed in 85 patients (13%) and had a higher in-hospital mortality than patients without acute kidney injury (14% vs 1%; p < 0.001). B-type natriuretic peptide levels were higher in acute kidney injury patients than in those without acute kidney injury (264 [112-957] vs 98 [44-271] pg/mL; p < 0.001) and showed a significant gradient according to acute kidney injury severity (224 [96-660] pg/mL in stage 1 and 939 [124-1,650] pg/mL in stage 2-3 acute kidney injury; p < 0.001). The risk of developing acute kidney injury increased in parallel with B-type natriuretic peptide quartiles (5%, 9%, 15%, and 24%, respectively; p < 0.001). When B-type natriuretic peptide was evaluated, in terms of capacity to predict acute kidney injury, the area under the curve was 0.702 (95% CI, 0.642-0.762).


CONCLUSIONS
In patients hospitalized with acute coronary syndromes, B-type natriuretic peptide levels measured at admission are associated with acute kidney injury as well as its severity.
1Intensive Cardiac Care Unit, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy. 2Division of Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Marco
M
Moltrasio
Angelo
A
Cabiati
Valentina
V
Milazzo
Mara
M
Rubino
Monica
M
De Metrio
Andrea
A
Discacciati
Paola
P
Rumi
Ivana
I
Marana
Giancarlo
G
Marenzi
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D015331:Cohort Studies; D003325:Coronary Care Units; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D015996:Survival Rate
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain