Combination of Amino‐Terminal Pro‐BNP, Estimated GFR, and High‐Sensitivity CRP for Predicting Cardiorenal Syndrome Type 1 in Acute Myocardial Infarction Patients

Abstract

Background Cardiorenal syndrome type 1 (CRS1) as a complication of acute myocardial infarction can lead to adverse outcomes, and a method for early detection is needed. This study investigated the individual and integrated effectiveness of amino‐terminal pro–brain natriuretic peptide (Pro‐BNP), estimated glomerular filtration rate (eGFR), and high‐sensitivity C‐reactive protein (CRP) as predictive factors for CRS1 in patients with acute myocardial infarction. Methods and Results In a retrospective analysis of 2094 patients with acute myocardial infarction, risk factors for CRS1 were analyzed by logistic regression. Receiver operating characteristic curves were constructed to determine the predictive ability of the biomarkers individually and in combination. Overall, 177 patients (8.45%) developed CRS1 during hospitalization. On multivariable analysis, all 3 biomarkers were independent predictors of CRS1 with odds radios and 95% confidence intervals for a 1‐SD change of 1.792 (1.311‐2.450) for log(amino‐terminal pro–brain natriuretic peptide, 0.424 (0.310‐0.576) for estimated glomerular filtration rate, and 1.429 (1.180‐1.747) for high‐sensitivity C‐reactive peptide. After propensity score matching, the biomarkers individually and together significantly predicted CRS1 with areas under the curve of 0.719 for amino‐terminal pro–brain natriuretic peptide, 0.843 for estimated glomerular filtration rate, 0.656 for high‐sensitivity C‐reactive peptide, and 0.863 for the 3‐marker panel (all P<0.001). Also, the integrated 3‐marker panel performed better than the individual markers (P<0.05). CRS1 risk correlated with the number of biomarkers showing abnormal levels. Abnormal measurements for at least 2 biomarkers indicated a greater risk of CRS1 (odds ratio 36.19, 95% confidence interval 8.534‐153.455, P<0.001). Conclusions The combination of amino‐terminal pro–brain natriuretic peptide, estimated glomerular filtration rate, and high‐sensitivity C‐reactive peptide at presentation may assist in the prediction of CRS1 and corresponding risk stratification in patients with acute myocardial infarction.

Keywords

• cardiorenal syndrome
• high‐sensitivity C‐reactive protein
• amino‐terminal pro–brain natriuretic peptide
• prediction