Low free triiodothyronine is associated with contrast-induced acute kidney injury and long-term outcome in elderly patients underwent percutaneous coronary intervention

Abstract

Objective: Low free triiodothyronine (fT 3 ) is common in elderly patients with cardiovascular disease. The purpose of this study was to evaluate the relationship between low fT 3 and contrast-induced acute kidney injury (CI-AKI), including the long-term outcomes, in elderly patients after a percutaneous coronary intervention (PCI). Methods: A total of 350 patients aged ≥75 years who underwent PCI between January 2012 and December 2015 were consecutively enrolled. The perioperative thyroid function, including fT 3 , was measured before PCI. A low fT 3 was defined as fT 3 <3.1 pmol/L with normal thyrotropin and free thyroxine. CI-AKI was defined as an absolute serum creatinine (SCr) increase ≥0.30 mg/dL or a relative increase in SCr ≥50% from the baseline value within 48 hours after contrast media exposure. A multivariate logistic regression analysis was applied to analyze whether low fT 3 was an independent risk factor for CI-AKI. The Cox regression analysis was used to evaluate the relationship between low fT 3 and long-term prognosis. Results: A total of 46 (13.1%) patients developed CI-AKI. The incidence of CI-AKI was significantly higher in the low fT 3 group than in the normal group (26.5% vs. 9.9%, p<0.01). A multivariable logistic analysis demonstrated that a low fT 3 level was significantly related to CI-AKI [odds ratio (OR)=2.41; 95% confidence interval (CI), 1.11–5.27; p=0.027]. The Cox regression analysis showed that a low fT 3 was associated with long-term mortality [adjusted hazard ratio (HR)=2.00; 95% CI, 1.04–3.83; p=0.037] during the follow-up of mean 1.67 years. Conclusion: A low fT 3 concentration was independently associated with CI-AKI and poor prognosis in elderly patients who had undergone PCI.

Machine Learning to Predict Contrast-Induced Acute Kidney Injury in Patients With Acute Myocardial Infarction

“…Combined with our results, CI-AKI is more likely to occur in the elderly and in patients with poor basal renal function. Consistent with our study, it is also reported that free triiodothyronine had a negative association with CI-AKI in patients undergoing primary PCI therapy (6,21). Preoperative hypotension may affect renal perfusion and lead to a higher risk of CI-AKI.…”

Negative association between free triiodothyronine level and contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention

“…Another study by Zhang D et al [18] including 1339 patients in the general intensive care units demonstrated that when Cystatin C (Cys C) was used for detecting early AKI, FT3 was found to be independently associated with Cys C. Furthermore, FT3 had no significant impact on the diagnostic and predictive accuracy of Cys C in detecting AKI in ICU patients. A more recent study by us firstly investigated the relationship between FT3 concentration and CI-AKI in patients aged > 75 years undergoing PCI, which showed the incidence of CI-AKI was about 1.4 folds higher in patients with low FT3 compared with normal FT3, suggesting low FT3 might be a novel risk factor for CI-AKI [31]. It's well-known that low FT3 is more frequent in critical ill patients such as myocardial infarction.…”

Urinary neutrophil gelatinase‐associated lipocalin predicted to contrast‐associated acute kidney injury after planned percutaneous coronary intervention in elderly patients

“…Clinically, the elevation of serum creatinine has occurred in patients receiving contrast media 21 . Elderly patients have a higher incidence of CA‐AKI than younger adults, and older age is a risk factor for CA‐AKI in patients after PCI 22–24 . There are several reasons for the high rate of AKI in the elderly after PCI compared to that in young people: the elderly have more complex coronary artery lesions than the younger population, and older people will undergo more complicated procedures than was the case in the past 25 .…”

“… 21 Elderly patients have a higher incidence of CA‐AKI than younger adults, and older age is a risk factor for CA‐AKI in patients after PCI. 22 , 23 , 24 There are several reasons for the high rate of AKI in the elderly after PCI compared to that in young people: the elderly have more complex coronary artery lesions than the younger population, and older people will undergo more complicated procedures than was the case in the past. 25 In addition, aging causes changes in renal function (increased renal excretion of sodium and water).…”