Predictive value of combining the level of fibrinogen and antithrombin III for contrast‑induced nephropathy in coronary artery disease patients undergoing percutaneous coronary intervention

Sun,Yanhu; Zheng,Di; Zhang,Quan; Li,Wenhua

doi:10.3892/br.2020.1333

Predictive value of combining the level of fibrinogen and antithrombin III for contrast‑induced nephropathy in coronary artery disease patients undergoing percutaneous coronary intervention

Authors:
- Yanhu Sun
- Di Zheng
- Quan Zhang
- Wenhua Li
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Affiliations: Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P.R. China
Published online on: July 22, 2020 https://doi.org/10.3892/br.2020.1333
Article Number: 26

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Abstract

Contrast‑induced nephropathy (CIN) is a common adverse event in the diagnosis and treatment of coronary intervention. The current study investigated the predictive effect of preoperative fibrinogen (FIB) combined with antithrombin III (AT‑III) on CIN following percutaneous coronary intervention (PCI). A total of 394 patients who underwent PCI between October 2018 and May 2019 were selected for the present study. Pre‑procedural FIB levels and AT‑III activity were measured before PCI. CIN was defined as a 0.5 mg/dl or 25% increase in serum creatinine levels 48 to 72 h after exposure to a radiocontrast agent. Patients were classified into CIN and non‑CIN groups. CIN occurred in 48 (12.2%) patients. The serum FIB levels were significantly higher in patients who developed CIN compared with those who did not develop CIN. In addition, AT‑III levels ≤89.5% were associated with higher rates of CIN. Logistical regression analysis showed that high FIB, and low AT‑III and albumin levels were high‑risk factors associated with CIN. For FIB, the area under the receiver operating characteristic curve (AUC) for predicting CIN was 0.653. The optimal cut‑off value was 3.48 g/l with a sensitivity of 45.8% and a specificity of 79.7% [95% confidence interval (CI): 0.603‑0.701; P=0.0002)]. For AT‑III, the AUC was 0.711, and the optimal cut‑off value was 89.5%, with a sensitivity of 81.3% and specificity of 58.2% (95% CI: 0.659‑0.758; P<0.0001). When combining FIB and AT‑III, the AUC was 0.747. The optimal cut‑off value was 0.090424, with a diagnostic sensitivity of 93.8% and specificity of 46.6% (95% CI: 0.697‑0.792; P<0.0001). The results showed that FIB combined with AT‑III resulted in improved predictive accuracy of CIN (FIB vs. AT‑III, AUC=0.653 vs. 0.711, P=0.292; FIB vs. FIB + AT‑III, AUC=0.653 vs. 0.747, P=0.012; AT‑III vs. FIB + AT‑III, AUC=0.711 vs. 0.747, P=0.138). Pre‑procedural levels of FIB, AT‑III and albumin were independently associated with an increased risk of CIN. Furthermore, the results suggested that the combination of FIB and AT‑III was a better predictor of CIN after PCI.

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