Association between high sensitivity C-reactive protein and contrast induced acute kidney injury in patients with acute coronary syndrome undergoing percutaneous coronary intervention: impact of atorvastatin / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the association between preprocedural high sensitivity C-reactive protein (hs-CRP) level and incidence of contrast induced acute kidney injury (CI-AKI) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) and the impact of atorvastatin pretreatment on CI-AKI.</p><p><b>METHODS</b>According to the level of preprocedural hs-CRP, 270 ACS patients were divided into three groups: high hs-CRP group (hs-CRP ≥ 3 mg/L, n = 176), moderate hs-CRP group (hs-CRP 1-3 mg/L, n = 60) and normal hs-CRP group (hs-CRP < 1 mg/L, n = 34). According to the dosage of preprocedural atorvastatin, the high hs-CRP group was further divided into 10 mg group (n = 49), 20 mg group (n = 66) and 40 mg group (n = 61). Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (Cys C), hs-CRP were measured at before and 24 hours, 48 hours after PCI. CCr and GFR were calculated according to Scr and Cys C. Risk factors for CI-AKI were determined by multivariate logistic regression analysis.</p><p><b>RESULTS</b>(1) Cys C was significantly increased and GFR after PCI significantly reduced in high and moderate hs-CRP groups compared with normal hs-CRP group (P < 0.05). (2) Incidence of CI-AKI was 43.18%, 38.33%, 20.59% in high, moderate and normal hs-CRP groups, respectively (P < 0.05). (3) In high hs-CRP group, postprocedural GFR was significantly higher while postprocedural Cys C and hs-CRP were significantly lower in 40 mg statin subgroup than 10 mg and 20 mg statin subgroups (P < 0.05), similar trends were documented when comparing 20 mg statin subgroup with 10 mg statin subgroup (P < 0.05). (4) Multivariate logistic regression analysis showed that pretreatment with high dose atorvastatin was a protective factor for post CI-AKI (20 mg atorvastatin: OR = 0.15, 95%CI 0.06 - 0.33, P = 0.001; 40 mg atorvastatin: OR = 0.10, 95%CI 0.04 - 0.23, P = 0.001), while high levels of preprocedural hs-CRP (OR = 2.06, 95%CI 1.01 - 4.23, P = 0.048), diabetes mellitus (OR = 10.71, 95%CI 5.29 - 21.70, P = 0.001), advanced age (OR = 2.64, 95%CI 1.05 - 6.63, P = 0.038) and renal failure (OR = 5.14, 95%CI 1.13 - 23.39, P = 0.034) were independent risk factors of CI-AKI.</p><p><b>CONCLUSION</b>High hs-CRP level is linked with the development of CI-AKI in ACS patients undergoing PCI and pretreatment with 40 mg atorvastatin is associated with lower incidence CI-AKI, possibly by reducing the postprocedural inflammation responses.</p>

Atorvastatin attenuated contrast induced renal function damage / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the effects of atorvastatin on contrast induced renal function change and plasma hsCRP in patients undergoing coronary angiography.</p><p><b>METHODS</b>120 patients who underwent coronary angiography were randomized to receive atorvastatin (20 mg/qn, n = 60) or no atorvastatin (n = 60) treatment 2 to 3 days before coronary angiography. Urinary alpha1-MG, TRF and mALB were checked for evidence of tubular or glomerular damage at start, 1 day and 2 days after the administration of a radiocontrast agent. Serum creatinine, BUN, cystatin C and hsCRP levels were also assessed at the same time. Ccr and GFR were calculated according to Cockcroft-Gault and GFR (ml/min) = 74.835/Cys C(1.333) formulas basing on serum creatinine or cystatin C concentration.</p><p><b>RESULTS</b>(1) In control group, comparison with the value before coronary angiography, urinary alpha1-MG, TRF and mALB or serum cystatin C and hsCRP significantly increased at day 1 after angiography (P < 0.01). In comparison to the levels at day 1 after angiography, urinary alpha1-MG, TRF, mALB, serum cystatin C significantly decreased at day 2 after angiography (P < 0.01), but alpha1-MG, cystatin C still exceeded the values before coronary angiography, TRF and mALB levels at day 2 after angiography had no significant change compared to baseline (P > 0.05), hsCRP level at day 2 after angiography had no significant change compared to that at day 1 after angiography (P > 0.05) too. (2) In comparison with the value before coronary angiography in atorvastatin-treated group, the levels of urinary alpha1-MG, TRF and mALB or serum cystatin C at day 1 and day 2 after angiography had no significant change compared to baseline (P > 0.05).Serum hsCRP significantly increased at day 1 after angiography compared to baseline (P < 0.01), but it had no significant change compared to day 2 after angiography (P > 0.05). (3) To compare to the atorvastatin-treated group, the values of urinary alpha1-MG, TRF and mALB or Cys C and hsCRP significantly increased at day 1 after angiography in control group (P < 0.01), the values of urinary alpha1-MG, cystatin C and hsCRP still significantly increased at day 2 (P < 0.01)too, but those of TRF and mALB had no significantly change at day 1 or day 2 after angiography between the two groups (P > 0.05). There was no significant change in BUN, Cr, Ccr levels before and after angiography between the two groups.</p><p><b>CONCLUSIONS</b>Low dose contrast induces light renal function damage. Pretreatment with atorvastatin 20 mg/qn for 2 to 3 days could significantly reduce procedural inflammatory reaction, attenuate urinary protein and the effect of degrading GFR in coronary angiography patients.</p>