AIM AIM To investigate the significance of urinary neutrophil gelatinase associated apolipoprotein (NGAL) in the early diagnosis of contrast induced nephropathy (CIN) after percutaneous coronary intervention (PCI) and related factors of CIN.
METHODS 208 patients with coronary heart disease underwent PCI after admission were selected, including 118 with hypertension, 106 with diabetes mellitus, 28 with chronic heart failure and 24 with chronic renal insufficiency. Serum creatinine and urinary NGAL content were measured before and at 4, 24, 48 and 72 hours after PCI and diagnostic evaluation of CIN was carried out. The incidence of contrast induced nephropathy was observed and major cardiovascular adverse events were also observed within one month after hospital discharge.
RESULTS After PCI, there were 31 CIN cases out of 208 and the postoperative incidence rate was 14.9%. The prevalence of diabetes mellitus and chronic heart failure and the incidence of MACE in the CIN group were significantly higher than those in the non-CIN group (P<0.05). Preoperative urinary NGAL levels in the CIN group and the non CIN group were similar and there was no significant difference between the two groups (P>0.05). Urinary NGAL levels in the CIN group began to increase from 4 hours after the operation and the levels were still rising at 72 hours, with statistical significance compared with that before operation (P<0.05). The urinary NGAL in the non CIN group was not significantly higher than that before operation. There was statistical difference in the content of urinary NGAL at the same time between the two groups (P<0.05). ROC curve analysis revealed that the area under the curve of 4 h, 24 h, 48 h and 72 h in each period of urinary NGAL(AUC) was respectively, 0.932, 0.946, 0.957 and 0.975, the sensitivity of diagnosis was 94% and the specificity was 100%. The area under the curve of postoperative SCr was 0.588, 0.562, 0.842, and 0.879, respectively. The sensitivity and specificity of the diagnosis of CIN were significantly lower than that of urinary NGAL Logistic multivariate regression analysis showed that diabetes mellitus, SCr, eGFR <60 ml/(min 1.73 m2),chronic heart failure(LVEF<35%)and glycosylated hemoglobin (>9.5%) were risk factors of CIN.
CONCLUSION Urinary NGAL has early diagnostic value for CIN after percutaneous coronary intervention. Diabetes mellitus, chronic renal insufficiency, and chronic heart failure are related factors of CIN. After the occurrence of CIN, adverse cardiovascular events were increased significantly.
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