Urinary interleukin-18 as an early indicator to predict contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Abstract

Contrast-induced nephropathy (CIN) is at present the third leading cause of hospital-acquired acute kidney injury (AKI). Traditionally, it is diagnosed by measuring an increase of the serum creatinine (SCr) concentration. However, SCr is an insensitive marker for detecting CIN. This study was designed to investigate whether human urinary interleukin-18 (IL-18) is early predictive marker for CIN following coronary interventional procedures. The general clinical data of 180 patients who underwent coronary interventional procedures at the Department of Cardiology, Affiliated Hospital of Xuzhou Medical College from March 1, 2012 to September 31, 2012 were collected. A nonionic, low osmolality contrast agent was used in the laboratory at this time. SCr values and estimated glomerular filtration rate (eGFR) were measured prior to and within 24 and 48 h after the administration of contrast agents. Urine samples were collected prior to and 2, 6, 12, 24 and 48 h after the coronary interventional procedure, and urinary IL-18 levels were measured using an ELISA kit. CIN was defined as an increase of ≥0.5 mg/dl or ≥25% in SCr concentration over baseline 24–48 h after the procedure. CIN occurred in 16 of 180 (8.9%) patients. The levels of urinary IL-18 measured 2 h after the procedure were increased in the CIN group, but the increase was not significant (P>0.05). There were significant differences (P<0.05) between the urinary IL-18 levels 6, 12, 24 and 48 h after the procedure and those before the procedure. No significant difference was identified between the SCr levels measured prior to and 24 h after the procedure. The area under the receiver operating characteristic (ROC) curve of urinary IL-18 12 h after the procedure was 0.811 and the 95% confidence interval of the area under the curve was 0.735–0.888. If the critical point of the diagnosis of CIN was 815.61 pg/ml, the sensitivity was 87.5% and the specificity was 62.2%. Univariate analysis indicated that the urinary IL-18 level was positively correlated with the SCr concentration pre- and postprocedure. In conclusion, urinary IL-18 may be a promising indicator for the early prediction of CIN.

Urinary renalase concentration in patients with preserved kidney function undergoing coronary angiography

“…It has been demonstrated that urinary neutrophil gelatinase‐associated lipocalin (NGAL; AUC = 0.96) and kidney injury molecule type 1 (KIM‐1; AUC = 0.71), performed better than liver fatty acid‐binding protein (L‐FABP; AUC = 0.64) assessed at 12 h following coronary angiography in the prediction of contrast‐induced nephropathy . Accordingly, urinary interleukin‐18 assessed at 6 h following CA/PCI has been shown to herald the onset of CI‐AKI (AUC = 0.81) . Although the aforementioned biomarkers exhibited higher predictive power towards CI‐AKI prediction than urinary renalase in our study, the application of different definitions of CI‐AKI in diverse populations precludes direct comparison of the results.…”

The potential use of biomarkers in predicting contrast-induced acute kidney injury

“…He et al 122 carried out a study on 180 patients who underwent coronary interventional procedures at the Department of Cardiology. Urine IL-18 levels were found to be increased in the CI-AKI patients 6-12 hours after the CM injection, compared with those in the non-CI-AKI patients (P<0.01).…”

Prediction of contrast‐induced acute kidney injury by early post‐procedural analysis of urinary biomarkers and intra‐renal Doppler flow indices in patients undergoing coronary angiography

“…Ling et al delivered preliminary evidence that urinary IL‐18 assessed at 24 h accurately identified patients at risk of CI‐AKI. This fact was later corroborated on 180 participants by He et al, who found that IL‐18 assayed at 12 h accurately selected subjects at risk of CI‐AKI (AUC = 0.81). Although urinary IL‐18 was higher in CI‐AKI than non‐CI‐AKI group at 6 h, only at 12 h did it reach statistical significance in ROC curve analysis.…”

“…Large body of evidence supports the use of urinary neutrophil gelatinase‐associated lipocalin (NGAL), however, little is known about the efficacy of other potential urinary biomarkers as an early CI‐AKI biomarkers, especially in the setting of patients with preserved baseline kidney function. Urinary interleukin 18 (IL‐18), kidney injury molecule type 1 (KIM‐1), and liver fatty acid‐binding protein (L‐FABP) have been so far evaluated as potential disease markers, but to date none of the studies has unequivocally proved the superiority of a single marker for CI‐AKI prediction.…”