Letter to Editor

Contrast-induced nephropathy prediction following ST-elevation myocardial infarction: Missing links

Dear Editor,

The study by Ceylan and Yildirim outlining H₂FPEF score as independent predictor of contrast-induced nephropathy (CIN) in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI), emerges as an exemplary research work.¹ Nonetheless, considering the relevance of the research subject, additional insights into the topic would certainly interest the Journal readership.

The authors retrospectively analyze the data of 355 patients, wherein one misses a comparative account of the serum albumin (SA) levels in the cohort developing CIN (n = 63) as opposed to those without CIN (n = 292).¹ The importance of the former is heralded by the Wiedermann et al meta-analysis suggesting a causal association between hypoalbuminemia and acute kidney injury (AKI), emanating from a total of 43 studies and 68,262 subjects.² Notably so, the meta-analysis included 8 studies with 4,344 patients combined from either cardiac surgical or PCI settings.²

More importantly, Murat et al retrospectively delineate significantly lower SA in their acute coronary syndrome (ACS) patients with contrast-induced AKI, or CI-AKI (n = 107) compared to those with normal renal function following PCI (n = 783) (3.52 ± 0.40 v/s 3.94 ± 0.39 mg/dL, P < 0.001).³ Subsequent to a multivariate analysis, the group highlights SA as an independent CI-AKI predictor (OR; 95% CI: 0.177; 0.080-0.392, P < 0.001) in a research scenario demonstrating peculiar similarities to the Ceylan and Yildirim study.^1,3

Ahead of the well-known pro-inflammatory links of both hypoalbuminemia and AKI, Wei et al elucidate a pivotal role of nutritional status in determining the eventual risk to contrast-induced renal injury in an elderly subset undergoing PCI.^2-5 Indeed, the dual relationship of SA with malnutrition and inflammation cannot be overemphasized, particularly in advanced age.^3,5 Moreover, whilst the inclusion of SA could have augmented the contextual research lucidity, the optimal CIN-predictive cut-off of the H₂FPEF score might also require further consolidation given the recent literature in the subject (H₂FPEF cut-off of 2.5 predicting CIN in ACS patients with 79.8% and 64.1% sensitivity-specificity in Ozbeyaz et al study vis-à-vis a CIN-predictive cut-off of 1.5 emanating from the Ceylan and Yildirim study and demonstrating a sensitivity-specificity of 64.0% and 72.1% in an exclusive STEMI cohort).^1,6

Competing Interests

Nothing to declare.

References

1. The relationship between H2FPEF score and contrast induced nephropathy in patients with ST elevation myocardial infarction. J Cardiovasc Thorac Res 2022; 14(4):240-5. doi: 10.34172/jcvtr.2022.30537 [Crossref]
2. Causal relationship between hypoalbuminemia and acute kidney injury. World J Nephrol 2017; 6(4):176-87. doi: 10.5527/wjn.v6.i4.176 [Crossref]
3. Impact of serum albumin levels on contrast-induced acute kidney injury in patients with acute coronary syndromes treated with percutaneous coronary intervention. Angiology 2015; 66(8):732-7. doi: 10.1177/0003319714551979 [Crossref]
4. Nitric oxide: renoprotective in cardiac surgery!. Braz J Cardiovasc Surg 2020; 35(4):602-3. doi: 10.21470/1678-9741-2020-0080 [Crossref]
5. Nutritional status and risk of contrast-associated acute kidney injury in elderly patients undergoing percutaneous coronary intervention. Clin Exp Nephrol 2021; 25(9):953-62. doi: 10.1007/s10157-021-02061-4 [Crossref]
6. H2FPEF score and contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Angiology 2023; 74(2):181-8. doi: 10.1177/00033197221099425 [Crossref]