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B-Type Natriuretic Peptide and Risk of Acute Kidney Injury in Patients Hospitalized With Acute Coronary Syndromes*

Moltrasio, Marco MD1; Cabiati, Angelo MD1; Milazzo, Valentina MD1; Rubino, Mara MD1; De Metrio, Monica MD1; Discacciati, Andrea MSc2; Rumi, Paola MLT1; Marana, Ivana MD1; Marenzi, Giancarlo MD1

Critical Care Medicine:
doi: 10.1097/CCM.0000000000000025
Clinical Investigations
Abstract

Objectives: To investigate whether admission B-type natriuretic peptide levels predict the development of acute kidney injury in acute coronary syndromes.

Design: Prospective study.

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

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

Interventions: None.

Measurements and Main 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.

Author Information

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.

* See also p. 746.

Supported, in part, by Centro Cardiologico Monzino, IRCCS.

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: giancarlo.marenzi@ccfm.it

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins