Application of kidney injury molecule-1 (KIM-1) for predicting urgent cardiovascular complications in acute cardiorenal syndrome

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Background. Patients with acute coronary artery disease (ACS) associated with oncological disease (OD) have a higher risk of adverse cardiovascular events than patients without OD, especially with the development of kidney disease. Currently new and improving existing prognostic scales are being created in order to improve the efficiency of predicting urgent cardiovascular complications (UCС) in this category of patients.

Objective. The development of an effective method for predicting urgent UCС in patients with ACS in combination with OD.

Material and methods. The study included 40 patients with ACS and OD (mean age 69±9 years, 65% men). Upon admission to the hospital all subjects were counted the number of points on the GRACE 2.0 scale, and the average portion of morning urine was collected to determine the content of KIM-1 (pg/ml). All patients were assessed for the development of urgent UCС in the hospital.

Results. The median KIM-1 in patients with ACS and OD was 921.0 (425.1–1314.8) pg/ml. The GRACE 2.0 scale had a satisfactory predictive value for urgent UCС: AUC=0.775 (95% CI 0.615–0.891; p < 0.001, >144 points). To improve the efficiency of predicting these complications, a comprehensive assessment of the possibility of using the GRACE 2.0 scale in combination with other indicators was carried out. A logistic regression analysis was performed, and two statistically significant variables were established (points on the GRACE 2.0 scale, KIM-1 value (pg/ml) in urine), a logistic regression equation was built: Y=-14.04813+(0.080005×points (GRACE 2.0 scale)+(0.0035426×KIM-1 value in urine). The variable “Y” was given the name “GRACE 2.0 – KIM-1”. According to the ROC-analysis it was determined that with the value of the indicator “GRACE 2.0 – KIM-1” more than -0.668390598 the risk of developing urgent UCС is higher: sensitivity 86.67% (95% CI 59.5–98.3), specificity 76.0% (95% CI 54.9–90.6), AUC=0.872 (95% CI 0.728–0.956; p<0.001). At the same time, the predictive value of the GRACE 2.0 – KIM-1 model increased by 12.5% compared to using only GRACE 2.0 scores.

Conclusion. The new model “GRACE 2.0 +– KIM-1” makes it possible to predict urgent UCC during the hospital period in patients with ACS in combination with OD.

Full Text

Restricted Access

About the authors

Dmitry V. Pivovarov

Municipal Clinical Hospital No. 38

Author for correspondence.
Email: pivovarov121094@yandex.ru
ORCID iD: 0000-0002-6642-1364

Cand.Sci. (Med.), Physician

Russian Federation, Nizhny Novgorod

Zinaida D. Mikhailova

Municipal Clinical Hospital No. 38

Email: zinaida.mihailowa@yandex.ru
ORCID iD: 0000-0002-0926-6038

Dr.Sci. (Med.), Assoc. Prof., Consulting Physician

Russian Federation, Nizhny Novgorod

References

  1. Резник Е.В., Никитин И.Г. Кардиоренальный синдром у больных с сердечной недостаточностью как этап кардиоренального континуума (Часть I): определение, классификация, патогенез, диагностика, эпидемиология (обзор литературы). Архивъ внутренней медицины. 2019;9(1):5–22. doi: 10.20514/2226-6704-2019-9-1-5-22. [Reznik E.V., Nikitin I.G. Cardiorenal syndrome in patients with heart failure as a stage of the cardiorenal continuum (Part I): definition, classification, pathogenesis, diagnosis, epidemiology (literature review). Rus. Arch. Int. Med. 2019;9(1):5–22 (In Russ.)].
  2. Шаленкова М.А., Михайлова З.Д., Климкин П.Ф. NGAL – маркер субклинического острого повреждения почек у больных острым коронарным синдромом. Клин. нефрология. 2018;2:43–9. doi: 10.18565/nephrology.2018.2.43-49. [Shalenkova M.A., Mihajlova Z.D., Klimkin P.F. NGAL is a marker of subclinical acute kidney injury in patients with acute coronary syndrome. Clin. Nephrol. 2018;2:43–9 (In Russ.)].
  3. Huyut M.A., Yamac A.H. Outcomes in Coronary No-Reflow Phenomenon Patients and the Relationship between Kidney Injury Molecule-1 and Coronary No-Reflow Phenomenon. Arq. Bras. Cardiol. 2021;116(2):238–47. doi: 10.36660/abc.20190656.
  4. Khreba N.A., Abdelsalam M., Wahab A.M., et al. Kidney Injury Molecule 1 (KIM-1) as an Early Predictor for Acute Kidney Injury in Post-Cardiopulmonary Bypass (CPB) in Open Heart Surgery Patients. Int. J. Nephrol. 2019;2019:6265307. doi: 10.1155/2019/6265307.
  5. Li Q., Huang Y., Shang W., et al. The Predictive Value of Urinary Kidney Injury Molecular 1 for the Diagnosis of Contrast-Induced Acute Kidney Injury after Cardiac Catheterization: A Meta-analysis. J. Interv. Cardiol. 2020;2020:4982987. doi: 10.1155/2020/4982987.
  6. Mughni M.A., Mateen M.A., Asifuddin M., et al. Chronic Kidney Disease of Unknown Etiology in a Tertiary Care Teaching Hospital. Cureus. 2023;15(2):e35446. doi: 10.7759/cureus.35446.
  7. Satirapoj B., Pooluea P., Nata N., et al. Urinary biomarkers of tubular injury to predict renal progression and end stage renal disease in type 2 diabetes mellitus with advanced nephropathy: A prospective cohort study. J. Diab. Complicat. 2019;33(9):675–81. doi: 10.1016/j.jdiacomp.2019.05.013.
  8. Wybraniec M.T., Chudek J., Mizia-Stec K. Association between elevated urinary levels of kidney injury molecule type 1 and adverse cardiovascular events at 12 months in patients with coronary artery disease. Pol. Arch. Intern. Med. 2018;128(5):301–9. doi: 10.20452/pamw.4242.
  9. Солохина М.П., Сергеева Н.С., Маршутина Н.В. и др. KIM-1 как потенциальный серологический/уринологичекий опухолеассоциированный маркер почечно-клеточного рака и нефротоксичности химиопрепаратов. Онкоурология. 2019;15(3):132–42. doi: 10.17650/1726-9776-2019-15-3-132–42. [Solokhina M.P., Sergeeva N.S., Marshutina N.V. et al. KIM-1 as a potential serological/urinological tumor-associated marker of renal cell carcinoma and chemotherapy nephrotoxicity. Onkourol. 2019;15(3):132–42 (In Russ.)].
  10. Milazzo V., Cosentino N., Campodonico J., et al. Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer. J. Clin. Med. 2020;9(11):3642. doi: 10.3390/jcm9113642.
  11. Radmilovic J., Di Vilio A., D’Andrea A., et al. The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome. J. Clin. Med. 2020;9(12):3926. doi: 10.3390/jcm9123926.
  12. Iannaccone M., D’Ascenzo F., Vadalà P., et al. Prevalence and outcome of patients with cancer and acute coronary syndrome undergoing percutaneous coronary intervention: a BleeMACS substudy. Eur. Heart J. Acute Cardiovasc. Care. 2018;7(7):631–8. doi: 10.1177/2048872617706501.
  13. Зыков М.В., Кашталап В.В., Быкова И.С. и др. Применение шкалы GRACE при остром коронарном синдроме в сочетании с почечной дисфункцией. Рос. кардиологический журнал. 2017;(11):36–42. doi: 10.15829/1560-4071-2017-11-36-42. [Zykov M.V., Kashtalap V.V., Bykova I.S. et al. Implementation of the GRACE score in acute coronary syndrome with renal dysfunction. Rus. J. Cardiol. 2017;(11):36–42 (In Russ.)].
  14. Барбараш О.Л., Дупляков Д.В., Затейщиков Д.А. и др. С. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2020. Рос. кардиологический журнал. 2021;26(4):4449. doi: 10.15829/1560-4071-2021-4449. [Barbarash O.L., Duplyakov D.V., Zateischikov D.A. et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Rus. J. Cardiol. 2021;26(4):4449 (In Russ.)].
  15. Styczkiewicz K., Styczkiewicz M., Myćka M., et al. Clinical presentation and treatment of acute coronary syndrome as well as 1-year survival of patients hospitalized due to cancer: A 7-year experience of a nonacademic center. Medicine (Baltimore). 2020;99(5):e18972. doi: 10.1097/MD.0000000000018972.
  16. Poldervaart J.M., Langedijk M., Backus B.E., et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int. J. Cardiol. 2017;227:656–61. doi: 10.1016/j.ijcard.2016.10.080.
  17. Ederhy S., Cohen A., Boccara F., et al. In-hospital outcomes and 5-year mortality following an acute myocardial infarction in patients with a history of cancer: Results from the French registry on Acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) 2005 cohort. Arch. Cardiovasc. Dis. 2019;112(11):657–69. doi: 10.1016/j.acvd.2019.06.012.
  18. Острый инфаркт миокарда с подъемом сегмента ST электрокардиограммы. Клинические рекомендации 2020. Российское кардиологическое общество, Ассоциация сердечно-сосудистых хирургов России. Рос. кардиологический журнал. 2020;25(11):4103. doi: 10.15829/1560-4071-2020-4103. [2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Rus. J. Cardiol. 2020;25(11):4103 (In Russ.)].
  19. Ассоциация нефрологов, Научное общество нефрологов России, Ассоциация анестезиологов-реаниматологов России, Национальное общество специалистов в области гемафереза и экстракорпоральной гемокорреции. Острое повреждение почек. Клинические рекомендации. 2020. [Электронный ресурс]. URL: https://www.rusnephrology. org/wp-content/uploads/2020/12/AKI_final.pdf (дата обращения: 27.03.2023). [Associaciya nefrologov, Nauchnoe obshchestvo nefrologov Rossii, Associaciya anesteziologov-reanimatologov Rossii, Nacional’noe obshchestvo specialistov v oblasti gemafereza i ekstrakorporal’noj gemokorrecii. Acute kidney injury. Clinical recommendations. 2020. [Electronic resource]. URL: https://www.rusnephrology. org/wp-content/uploads/2020/12/ AKI_final.pdf (data of the application: 27.03.2023) (In Russ.)].
  20. Ассоциация нефрологов. Хроническая болезнь почек. Клинические рекомендации. 2021. [Электронный ресурс]. URL: https://www.rusnephrology.org/wp-content/uploads/2020/12/CKD_final.pdf (дата обращения: 27.03.2023). [Associaciya nefrologov. Chronic kidney disease. Clinical recommendations. 2021. [Electronic resource]. URL: https://www.rusnephrology.org/wp-content/uploads/2020/12/CKD_final.pdf (data of the application: 27.03.2023) (In Russ.)].
  21. Петри А., Сэбин К. Наглядная медицинская статистика. Учебное пособие. Пер. с англ. под ред. В.П. Леонова. М., 2019. 216 с. [Petri A., Sebin K. Visual medical statistics. Study guide. Translated from English. Ed. N.V. V.P. Leonov. M., 2019. 216 p. (In Russ.)].
  22. Канукоев К.Ю., Сергеева Н.С., Кармакова Т.А. и др. KIM-1 (kidney injury molecule 1) в моче больных почечно-клеточным раком. Онкоурология. 2020;16(3):21–8. doi: 10.17650/1726-9776-2020-16-3-21-28. [Kanukoev K.Yu., Sergeeva N.S., Karmakova T.A., et al. KIM-1 (kidney injury molecule 1) in urine of patients with renal cell carcinoma. Onkourol. 2020;16(3):21–8 (In Russ.)].
  23. Михайлова З.Д., Пивоваров Д.В., Румянцева С.М. и др. KIM-1 как биомаркер острого повреждения почек у пациентов с острым коронарным синдромом и онкологическими заболеваниями. Клин. нефрология. 2021;13(1):50–5. doi: 10.18565/nephrology.2021.1.50-55. [Mikhailova Z.D., Pivovarov D.V., Rumyantseva S.M., et al. KIM-1 as a biomarker of acute kidney injury in patients with acute coronary syndrome and cancer. Clin. Nephrol. 2021;13(1):50–5 (In Russ.)].
  24. Михайлова З.Д., Пивоваров Д.В., Пивоварова А.Р.Способ прогнозирования неблагоприятных кардиоваскулярных исходов острого коронарного синдрома в течение госпитального периода у пациентов с онкологическими заболеваниями: пат. 2751808 Российская Федерация: МПК G01N 33/68 (2006.01). Заявитель и патентообладатель Михайлова З.Д., Пивоваров Д.В. №2020141692; заявл.16.12.2020; опубл. 19.07.2021, Бюллетень. №20. 11 с. [Mikhailova Z.D., Pivovarov D.V., Pivovarova A.R.A method for predicting unfavorable cardiovascular outcomes of acute coronary syndrome during the hospital period in patients with oncological diseases: pat. 2751808 Russian Federation: IPC G01N 33/68 (2006.01); applicant and patent holder Mikhailova Z.D., Pivovarov D.V. No.2020141692; application.16.12.2020; publ. 19.07.2021, Bulletin. No. 20. 11 p. (In Russ.)].
  25. Лубоятникова Е.С., Дупляков Д.В. Острый коронарный синдром у пациентов со злокачественными новообразованиями. Рос. кардиологический журнал. 2017;(3):140–44. doi: 10.15829/1560-4071-2017-3-140-144. [Luboyatnikova E.S., Duplyakov D.V. Acute coronary syndrome in malignancy patients. Rus. J. Cardiol. 2017;(3):140–44 (In Russ.)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. Comparison of the ROC curves of the "GRACE 2.0 - KIM-1" indicator and points on the GRACE 2.0 scale for predicting the development of urgent CVS in the hospital period in patients with ACS and OZ

Download (60KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies