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Association of serum bilirubin with contrast-induced nephropathy and future cardiovascular events in patients undergoing coronary intervention.

Huang SS, Huang PH, Wu TC, Chen JW, Lin SJ - PLoS ONE (2012)

Bottom Line: CIN is a serious complication of coronary intervention.Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events.The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT

Objectives: Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention.

Methods: Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke.

Results: Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25-43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05-4.90).

Conclusions: CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

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Related in: MedlinePlus

Incidence of contrast-induced nephropathy in patients stratified into low-bilirubin (ā‰¤0.5 mg/dl, nā€Š=ā€Š181), normal-bilirubin (>0.5 and ā‰¤0.7 mg/dl, nā€Š=ā€Š181) and high-bilirubin (>0.7 mg/dl, nā€Š=ā€Š182) groups.P<0.001.
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pone-0042594-g001: Incidence of contrast-induced nephropathy in patients stratified into low-bilirubin (ā‰¤0.5 mg/dl, nā€Š=ā€Š181), normal-bilirubin (>0.5 and ā‰¤0.7 mg/dl, nā€Š=ā€Š181) and high-bilirubin (>0.7 mg/dl, nā€Š=ā€Š182) groups.P<0.001.

Mentions: As shown in Table 3, patients in the low-bilirubin group tended to be older and had a higher prevalence of diabetes and CKD than patients in the high-bilirubin group. The incidence of CIN was significantly reduced in the high-bilirubin group (P<0.001), as illustrated in Figure 1. Patients in the high-bilirubin group had less cardiovascular death and all-cause mortality than those in the low-bilirubin group. The incidence of MACE was also significantly decreased in the high-bilirubin group compared with that in the low-bilirubin group (13.7% vs. 30.4%, Pā€Š=ā€Š0.001), as shown in Table 4. In addition, higher serum bilirubin concentrations were associated with a significant decrease in the odds of MACE at discharge, 1 year and 3 years, which result in odds ratio (OR) [95% confidence interval (CI)] of 0.12 (0.02 to 0.81), 0.35 (0.13 to 0.95), and 0.20 (0.08 to 0.46), respectively.


Association of serum bilirubin with contrast-induced nephropathy and future cardiovascular events in patients undergoing coronary intervention.

Huang SS, Huang PH, Wu TC, Chen JW, Lin SJ - PLoS ONE (2012)

Incidence of contrast-induced nephropathy in patients stratified into low-bilirubin (ā‰¤0.5 mg/dl, nā€Š=ā€Š181), normal-bilirubin (>0.5 and ā‰¤0.7 mg/dl, nā€Š=ā€Š181) and high-bilirubin (>0.7 mg/dl, nā€Š=ā€Š182) groups.P<0.001.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3412818&req=5

pone-0042594-g001: Incidence of contrast-induced nephropathy in patients stratified into low-bilirubin (ā‰¤0.5 mg/dl, nā€Š=ā€Š181), normal-bilirubin (>0.5 and ā‰¤0.7 mg/dl, nā€Š=ā€Š181) and high-bilirubin (>0.7 mg/dl, nā€Š=ā€Š182) groups.P<0.001.
Mentions: As shown in Table 3, patients in the low-bilirubin group tended to be older and had a higher prevalence of diabetes and CKD than patients in the high-bilirubin group. The incidence of CIN was significantly reduced in the high-bilirubin group (P<0.001), as illustrated in Figure 1. Patients in the high-bilirubin group had less cardiovascular death and all-cause mortality than those in the low-bilirubin group. The incidence of MACE was also significantly decreased in the high-bilirubin group compared with that in the low-bilirubin group (13.7% vs. 30.4%, Pā€Š=ā€Š0.001), as shown in Table 4. In addition, higher serum bilirubin concentrations were associated with a significant decrease in the odds of MACE at discharge, 1 year and 3 years, which result in odds ratio (OR) [95% confidence interval (CI)] of 0.12 (0.02 to 0.81), 0.35 (0.13 to 0.95), and 0.20 (0.08 to 0.46), respectively.

Bottom Line: CIN is a serious complication of coronary intervention.Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events.The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan.

ABSTRACT

Objectives: Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention.

Methods: Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke.

Results: Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25-43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05-4.90).

Conclusions: CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.

Show MeSH
Related in: MedlinePlus