Background. Contrast-associated acute kidney injury (CA-AKI) is a common complication in patients undergoing coronary angiography (CAG). However, few studies demonstrate the association between the prognosis and developed CA-AKI in the different periods after the operation. Methods. We retrospectively enrolled 3206 patients with preoperative serum creatinine (Scr) and at least twice SCr measurement after CAG. CA-AKI was defined as an increase ≥50% or ≥0.3 mg/dL from baseline in the 72 hours after the procedure. Early CA-AKI was defined as having the first increase in SCr within the early phase (<24 hours), and late CA-AKI was defined as an increase in SCr that occurred for the first time in the late phase (24–72 hours). The first endpoint of this study was long-term all-cause mortality. Kaplan–Meier analysis was used to count the cumulative mortality, and the log-rank test was used to assess differences between curves. Univariate and multivariate cox regression analyses were performed to assess whether patients who developed different type CA-AKI were at increased risk of long-term mortality. Results. The number of deaths in the 3 groups was 407 for normal (12.7%), 106 for early CA-AKI (32.7%) and 57 for late CA-AKI (17.7%), during a median follow-up period of 3.95 years. After adjusting for important clinical variables, early CA-AKI (HR = 1.33, 95% CI: 1.02–1.74, ) was significantly associated with mortality, while late CA-AKI (HR = 0.92, 95% CI: 0.65–1.31, ) was not. The same results were found in patients with coronary artery disease, chronic kidney disease, diabetes mellitus, and percutaneous coronary intervention. Conclusions. Early increases in Scr, i.e., early CA-AKI, have better predictive value for long-term mortality. Therefore, in clinical practice, physicians should pay more attention to patients with early renal injury related to long-term prognosis and give active treatment.

中文翻译：

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接受冠状动脉造影的患者早期和晚期对比剂相关急性肾损伤与长期死亡率的关系


背景。造影剂相关急性肾损伤（CA-AKI）是接受冠状动脉造影（CAG）患者的常见并发症。然而，很少有研究证明预后与术后不同时期发生CA-AKI之间的关系。方法。我们回顾性纳入了 3206 名术前血清肌酐 (Scr) 且在 CAG 后至少进行两次 SCr 测量的患者。 CA-AKI 定义为术后 72 小时内较基线增加 ≥50% 或 ≥0.3 mg/dL。早期 CA-AKI 定义为 SCr 在早期阶段（<24 小时）首次升高，晚期 CA-AKI 定义为 SCr 首次升高发生在晚期阶段（24-72 小时） ）。这项研究的第一个终点是长期全因死亡率。 Kaplan-Meier 分析用于计算累积死亡率，对数秩检验用于评估曲线之间的差异。进行单变量和多变量 Cox 回归分析，以评估发生不同类型 CA-AKI 的患者长期死亡风险是否增加。结果。在中位随访时间为 3.95 年期间，3 组的死亡人数为正常组 407 例（12.7%）、早期 CA-AKI 106 例（32.7%）和晚期 CA-AKI 57 例（17.7%）。调整重要的临床变量后，早期 CA-AKI（HR = 1.33，95% CI：1.02–1.74，）与死亡率显着相关，而晚期 CA-AKI（HR = 0.92，95% CI：0.65–1）。31、 ）不是。在患有冠状动脉疾病、慢性肾病、糖尿病和经皮冠状动脉介入治疗的患者中也发现了相同的结果。结论。 Scr的早期升高，即早期CA-AKI，对长期死亡率具有更好的预测价值。因此，在临床实践中，医师应更加关注与长期预后相关的早期肾损伤患者并给予积极治疗。