Growth differentiation factor-15 levels and the risk of contrast induced acute kidney injury in acute myocardial infarction patients treated invasively: A propensity-score match analysis

March Growth differentiation factor-15 levels and the risk of contrast induced acute kidney injury in acute myocardial infarction patients treated invasively: A propensity-score match analysis Ling Sun 0 1 2 Xuejun Zhou 0 1 2 Jianguang Jiang 0 1 2 Xuan Zang 0 1 2 Xin Chen 0 1 2 Haiyan Li 0 1 2 Haitao Cao 0 1 2 Qingjie Wang 0 1 2 0 Department of Cardiology, Changzhou No.2 people's Hospital, Affiliated to Nanjing Medical University , Changzhou , China 1 Health Commission of Science and Research Foundation (2017-KY011-01) to Qingjie Wang, and Nanjing Medical University Research Foundation (FZSQN-201762) to Ling Sun 2 Editor: Gianpaolo Reboldi, Universita degli Studi di Perugia , ITALY Growth differentiation factor-15 (GDF-15) is an emerging biomarker for risk stratification in cardiovascular disease. Contrast-induced acute kidney injury (AKI) is an important complication in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). In this retrospectively observational study, we aimed to determine the role of GDF-15 and the risk of AKI in acute myocardial infarction (AMI) patients. - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Competing interests: The authors have declared that no competing interests exist. Background Methods The medical records of 1195 patients with AMI were reviewed. After exclusion criteria, a total of 751 eligible patients who underwent CAG or PCI were studied. Preoperative clinical parameters including GDF-15 levels were recorded. Multivariate logistic regression analysis was used to identify the risk factors of AKI. Subsequently, to reduce a potential selection bias and to balance differences between the two groups, a propensity score-matched analysis was performed. We recorded the 30-day all-cause mortality of the total study population. Kaplan-Meier analysis was performed to identify the association between short term survival in AMI patients and GDF-15 level. Results Among 751 enrolled patients, 106 patients (14.1%) developed AKI. Patients were divided into two groups: AKI group (n = 106) and non-AKI group (n = 645). GDF-15 levels were significantly higher in AKI group compared to non-AKI group (1328.2 ± 349.7 ng/L vs. 1113.0 ± 371.3 ng/L, P <0.001). Multivariate logistic regression analyses showed GDF-15 was an independent risk factor of AKI (per 1000 ng/L increase of GDF-15, OR: 3.740, 95% CI: 1.940±7.207, P < 0.001). According to GDF-15 tertiles, patients were divided into three groups. Patients in middle (OR 2.93, 95% CI: 1.46±5.89, P = 0.003) and highest GDF-15 tertile (OR 3.72, 95% CI: 1.87±7.39, P <0.001) had higher risk of AKI compared to patients in the lowest GDF-15 tertile. The propensity score-matched group set comprised of 212 patients. Multivariate logistic regression revealed that GDF-15 is still an independent risk factor for AKI after matching (per 1000 ng/L increase of GDF-15, OR: 2.395, 95% CI: 1.020±5.626, P = 0.045). Based on the Kaplan-Meier analysis, the risk of 30-day all-cause mortality increased in higher GDF-15 tertiles log rank chi-square: 29.895, P <0.001). Conclusion This suggests that preoperative plasma GDF-15 is an independent risk factor of AKI in AMI patients underwent CAG or PCI. GDF-15 and AKI are associated with poor short term survival of AMI patients. Introduction Contrast induced acute kidney injury (AKI) is a significant and common complication in patients with acute myocardial infraction (AMI) undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). An increasing number of studies have shown that AKI is associated with increased mortality and morbidity in AMI patients[1±3]. However, the pathophysiology of contrast induced AKI remains unclear. There are polyfactorial pathophysiologies of this complication, including inflammation and oxidative stress, hemodynamic disorders, and renal ischemia-reperfusion injury. There is no completely successful prevention for this disease[ 4, 5 ]. Thus, identification of AMI patients who may be able to develop AKI after interventions is necessary to prevent AKI in the future[ 6, 7 ]. Some risk biomarkers are thought to be related to AKI. Different scores have been developed based on these risk factors to predict the incidence of AKI after CAG or PCI[ 2, 8, 9 ]. For example, AGEF risk score, a 3-variables clinical risk score based on age, left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR), was able to predict contrast-induced nephropathy (CIN) in AMI patients undergoing PCI[10]. However, all risk scores exhibited low predictive accuracy for AKI and 3-year MACEs[11]. Thus, it is necessary to find a biomarker for AKI which could be easily measured before CAG or AKI and is more accurate in predicting AKI. Some potential candidates might be the cardiac or renal biomarkers. In addition, the plasma concentration of the Growth Differenti (...truncated)