Zhongguo quanke yixue (Sep 2024)
Diagnostic Value of Serum NLRP3 Levels and Contrast Agent Dosage in Contrast-induced Nephropathy after Percutaneous Coronary Intervention in Patients with Acute ST-elevation Myocardial Infarction
Abstract
Background Acute ST-elevation myocardial infarction (STEMI) represents a critical cardiovascular emergency, with percutaneous coronary intervention (PCI) being the preferred treatment. Post-PCI, patients are prone to developing contrast-induced nephropathy (CIN), significantly increasing the risk of adverse events. Thus, early diagnosis and treatment are crucial. Objective This study aims to investigate the diagnostic value of serum levels of NOD-like receptor pyrin domain-containing 3 (NLRP3) and the dosage of contrast agents for CIN following PCI in patients with STEMI. Methods The study included 257 patients diagnosed with STEMI and undergoing emergency PCI at the First People's Hospital of Kashi from June to December 2022. Based on the occurrence of CIN within 24 to 48 hours post-PCI, participants were divided into two groups: 61 in the CIN group and 196 in the non-CIN group. Basic clinical data of patients were collected, along with the dosage of contrast agents used during the procedure. On the second day of hospitalization, fasting venous blood was drawn to assess renal function indicators, lipid profiles, blood glucose, and serum NLRP3 levels, alongside echocardiographic evaluation of the left ventricular ejection fraction (LVEF). Multivariate Logistic regression analysis was utilized to explore factors influencing CIN development. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic value of serum NLRP3 levels and contrast agent dosage for CIN. Results The CIN group showed a lower proportion of males, lower preoperative levels of uric acid and albumin, and higher levels of contrast agent dosage and NLRP3 compared to the non-CIN group (P<0.05). The multivariate Logistic regression analysis indicated that increased contrast agent dosage (OR=1.008, 95%CI=1.001-1.015, P=0.017) and elevated serum NLRP3 levels (OR=1.139, 95%CI=1.054-1.230, P=0.001) are risk factors for CIN. ROC curve analysis revealed that the area under curve (AUC) for contrast agent dosage, serum NLRP3 levels, and their combined use in diagnosing CIN post-PCI in acute myocardial infarction were 0.797 (95%CI=0.716-0.879), 0.885 (95%CI=0.828-0.942), and 0.939 (95%CI=0.896-0.981), respectively. Conclusion In patients with STEMI, contrast agent dosage and serum NLRP3 levels are risk factors for CIN following PCI and can serve as predictive indicators. The combined use of these factors offers a more definitive diagnostic value for CIN.
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