The relationship between pre-procedural elevated arterial lactate and contrast-induced nephropathy following primary percutaneous coronary intervention

Abstract

Background: Risk stratification has been one of the main steps in preventing contrast-induced nephropathy (CIN), which is a common complication after percutaneous coronary intervention (PCI). Elevated arterial lactate is a biomarker indicating severe disease condition and post-intervention complications. The relationship between lactate and CIN has not been established. This study is performed to investigate the relationship between elevated arterial lactate level and contrast-induced nephropathy (CIN). Methods:Patients diagnosed with ST-segment elevated myocardial infarction (STEMI) were prospectively enrolled, with lactate measured within 0.5-1 hours before primary percutaneous coronary intervention (PCI).Patients with cardiopulmonary resuscitation, any forms of severe anaerobic condition, or end-stage renal disease undergoing dialysis were excluded. CIN was defined as an increase in serum creatinine ≥0.5 mg/dL or 25% within 72 hours after PCI. The Mehran Risk Score (MRS) is widely regarded as a classic risk model for CIN and the risk factors of MRS were applied in our multivariate regression analysis. Results: Of the 227 enrolled patients, 47 (20.7%) developed CIN according to the definition. The mean lactate level was higher in the CIN group than in the non-CIN group (2.68±2.27 vs. 1.74±1.94, P<0.001).The arterial lactate level ≥2.0 mmol/L had 57.5% sensitivity and 75.6% specificity in predicting CIN.The performance of the lactate level in discriminating CIN was similar to that of the MRS (AUC lac =0.707 vs.

Lactate level and lactate clearance for acute kidney injury prediction among patients admitted with ST-segment elevation myocardial infarction: A retrospective cohort study

“…Arterial lactate was recently introduced as a parameter in the CRATE score for AKI prediction among patients who underwent cardiac surgery ( 13 ). Moreover, Yang et al ( 22 ) found that lactate level performance in predicting CIN among patients with STEMI following PPCI was similar to that of the MRS, a widely used and externally validated model ( 2 , 23 ). However, data regarding the additional value of lactate parameters in MRS for AKI prediction among such patients is lacking.…”

“…Yan et al ( 21 ) analyzed 280 patients with AMI who underwent emergency PCI and demonstrated that high lactate levels at baseline were associated with an increased risk of contrast-induced AKI. A previous study that evaluated 227 patients with STEMI revealed that a pre-procedural arterial lactate level of ≥ 2.0 mmol/L was a predictive factor of CIN ( 22 ). However, both studies were limited by their small sample sizes and they only investigated the predictive value of baseline lactate levels.…”

Interaction between Hyperuricemia and Admission Lactate Increases the Risk of Acute Kidney Injury in Patients with ST-Segment Elevation Myocardial Infarction

“…Of note, serum lactate is an indicator of disease severity. Previous reports indicate that baseline high lactate levels are associated with an increased risk of contrast-induced acute kidney injury and poor cardiorenal outcomes in acute myocardial infarction patients undergoing emergency PCI [12][13][14][15]. So far, research establishing whether the relationship between hyperuricemia and AKI in STEMI patients is modified by lactate remains unpublished.…”