Fibrinogen-to-Albumin Ratio Predicts Postcontrast Acute Kidney Injury in Patients with Non-ST Elevation Acute Coronary Syndrome after Implantation of Drug-Eluting Stents

Abstract

Background. Postcontrast acute kidney injury (PC-AKI) is an adverse reaction to iodinated contrast agents. In this study, we investigated the use of fibrinogen-to-albumin ratio (FAR) as a novel inflammatory marker to track the development and progression of PC-AKI in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) after the implantation of drug-eluting stents (DESs). Methods. A total of 872 patients with NSTE-ACS were enrolled in this study. PC-AKI was identified when serum creatinine (SCr) levels increased >26.5 mol/L (0.3 mg/dL) or was 1.5 times the baseline level within 48–72 h of exposure to an iodinated contrast agent. The effects of different variables on PC-AKI were evaluated using univariate regression analysis. Multivariate logistic regression analysis was used to determine the independent predictors of PC-AKI. The predictive value of FAR was assessed by estimating the area under the receiver operating characteristic (ROC) curve. Results. In total, 114 (13.1%) patients developed PC-AKI. The patients with PC-AKI had lower albumin levels ( 40.5 ± 3.4 vs. 39.0 ± 3.5 , P < 0.001 ), higher fibrinogen levels ( 3.7 ± 0.6 vs. 4.1 ± 0.5 , P < 0.001 ), and higher FAR levels ( 9.2 ± 1.7 vs. 10.5 ± 1.7 , P < 0.001 ) than those with non-PC-AKI. There were no significant differences in the preoperative SCr levels between the two groups. After adjusting for confounding factors, FAR was found to be an independent predictor of PC-AKI ( OR = 1.478 , 95% CI = 1.298 – 1.684 , P < 0.001 ). ROC analysis revealed that for PC-AKI prediction, the area under the curve for FAR was 0.702. The optimum cut-off value of FAR was 10.0, with a sensitivity of 64.9% and a specificity of 69.8%. Moreover, FAR had a higher predictive value for PC-AKI than the Mehran score (0.702 vs. 0.645). Conclusion. Our study showed that elevated preoperative FAR was closely associated with the development of PC-AKI in patients with NSTE-ACS after implantation of DESs. Therefore, it may be worth monitoring FAR as a guide for using preventive measures to avoid the development of PC-AKI.

The elevated lactate dehydrogenase to albumin ratio is a risk factor for developing sepsis-associated acute kidney injury: a single-center retrospective study

“…In addition, serum albumin can serve as a predictor of AKI [ 21 ]. Several combined indicators with albumin showed strong predictive and prognostic value for AKI, such as the fibrinogen to albumin ratio [ 22 ], uric acid to albumin ratio [ 23 ] and lactate to albumin ratio [ 24 ].…”