Critical Care Medicine

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

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

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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.

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

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