Association of decreasing hemoglobin levels with the incidence of acute kidney injury after percutaneous coronary interv
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ORIGINAL ARTICLE
Association of decreasing hemoglobin levels with the incidence of acute kidney injury after percutaneous coronary intervention: a prospective multi‑center study Toshiki Kuno1 · Yohei Numasawa2 · Takahisa Mikami1 · Nozomi Niimi3 · Mitsuaki Sawano3 · Masaki Kodaira1 · Masahiro Suzuki4 · Koji Ueno5 · Ikuko Ueda3 · Keiichi Fukuda3 · Shun Kohsaka3 Received: 30 June 2020 / Accepted: 18 September 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Acute kidney injury (AKI) is common in patients undergoing percutaneous coronary intervention (PCI). One risk factor for AKI is periprocedural hemoglobin drop level (> 3 g/dL); however, whether the relationship between hemoglobin drop and AKI is linear or nonlinear remains unknown. We aimed to investigate the relationship between periprocedural hemoglobin drop and AKI after PCI. We evaluated 14,273 consecutive patients undergoing PCI between September 2008 and March 2019. AKI was defined as an absolute or a relative increase in serum creatinine level of 0.3 mg/dL or 50%, respectively. Restricted cubic spline was constructed to assess the association between hemoglobin drop and AKI by logistic regression and machine learning (ML) models, which were used to predict the risk of AKI. The patients’ mean age was 68.4 ± 11.6 years; the AKI incidence was 10.5% (N = 1499). An absolute > 3 g/dL or 20% relative decrease in hemoglobin level was an independent predictor of AKI incidence (odds ratio, OR [95% confidence interval, CI]: 2.24 [1.92–2.61], P 3 g/dl decrease in hemoglobin level or a 20% relative decrease in hemoglobin demonstrated that they were independent predictors for the incidence of AKI (odds ratio, OR [95% confidence interval, CI]: 2.24 [1.92–2.61], P 20% was an independent predictor for the incidence of AKI after PCI along with absolute decrease of hemoglobin by > 3 g/dL (3) full adjusted restricted cubic spline demonstrated a linear association of absolute/relative decrease in periprocedural hemoglobin after PCI with AKI (4) ML provided a comparable model to estimate the incidence of AKI with the logistic model. Detecting the absolute/relative decrease in
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Table 1 Baseline characteristics of all patients Without Hemoglobin drop > 3 g/dl or 20% With Hemoglobin drop > 3 g/dl or 20% decrease (N = 12,330) decrease (N = 1943) Age Female Creatinine value (mg/dl) Creatinine clearance (ml/min.) Baseline Hemoglobin (g/dl) Previous myocardial infarction Previous heart failure Diabetes mellitus Diabetes mellitus with insulin Cerebrovascular disease Peripheral artery disease Chronic lung disease Hypertension Dyslipidemia Previous PCI Previous coronary bypass Heart failure on admission Cardiogenic shock on admission Cardiopulmonary arrest on admission Radial artery approach Intra aortic balloon pump ST-elevation myocardial infarction UA/NSTEMI
68.3 ± 11.4 20.0% (2470) 0.99 ± 0.64 63.9 ± 22.0 13.4 ± 1.97 22.2% (2743) 9.1% (1116) 41.0% (5057) 7.4% (908) 8.8% (1086) 7.9% (975) 3.3% (412) 73.4% (9053) 64.8% (7990) 34.6% (4268)
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