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Application of kidney injury molecule-1 (KIM-1) for predicting urgent cardiovascular complications in acute cardiorenal syndrome
DOI: https://dx.doi.org/10.18565/nephrology.2024.1.37-42
Pivovarov D.V., Mikhailova Z.D.
Municipal Clinical Hospital No. 38; Nizhny Novgorod, Russia
Background. Patients with acute coronary artery disease (ACS) associated with oncological disease (OD) have a higher risk of adverse cardiovascular events than patients without OD, especially with the development of kidney disease. Currently new and improving existing prognostic scales are being created in order to improve the efficiency of predicting urgent cardiovascular complications (UCС) in this category of patients.
Objective. The development of an effective method for predicting urgent UCС in patients with ACS in combination with OD.
Material and methods. The study included 40 patients with ACS and OD (mean age 69±9 years, 65% men). Upon admission to the hospital all subjects were counted the number of points on the GRACE 2.0 scale, and the average portion of morning urine was collected to determine the content of KIM-1 (pg/ml). All patients were assessed for the development of urgent UCС in the hospital.
Results. The median KIM-1 in patients with ACS and OD was 921.0 (425.1–1314.8) pg/ml. The GRACE 2.0 scale had a satisfactory predictive value for urgent UCС: AUC=0.775 (95% CI 0.615–0.891; p < 0.001, >144 points). To improve the efficiency of predicting these complications, a comprehensive assessment of the possibility of using the GRACE 2.0 scale in combination with other indicators was carried out. A logistic regression analysis was performed, and two statistically significant variables were established (points on the GRACE 2.0 scale, KIM-1 value (pg/ml) in urine), a logistic regression equation was built: Y=-14.04813+(0.080005×points (GRACE 2.0 scale)+(0.0035426×KIM-1 value in urine). The variable “Y” was given the name “GRACE 2.0 – KIM-1”. According to the ROC-analysis it was determined that with the value of the indicator “GRACE 2.0 – KIM-1” more than -0.668390598 the risk of developing urgent UCС is higher: sensitivity 86.67% (95% CI 59.5–98.3), specificity 76.0% (95% CI 54.9–90.6), AUC=0.872 (95% CI 0.728–0.956; p<0.001). At the same time, the predictive value of the GRACE 2.0 – KIM-1 model increased by 12.5% compared to using only GRACE 2.0 scores.
Conclusion. The new model “GRACE 2.0 +– KIM-1” makes it possible to predict urgent UCC during the hospital period in patients with ACS in combination with OD.
Objective. The development of an effective method for predicting urgent UCС in patients with ACS in combination with OD.
Material and methods. The study included 40 patients with ACS and OD (mean age 69±9 years, 65% men). Upon admission to the hospital all subjects were counted the number of points on the GRACE 2.0 scale, and the average portion of morning urine was collected to determine the content of KIM-1 (pg/ml). All patients were assessed for the development of urgent UCС in the hospital.
Results. The median KIM-1 in patients with ACS and OD was 921.0 (425.1–1314.8) pg/ml. The GRACE 2.0 scale had a satisfactory predictive value for urgent UCС: AUC=0.775 (95% CI 0.615–0.891; p < 0.001, >144 points). To improve the efficiency of predicting these complications, a comprehensive assessment of the possibility of using the GRACE 2.0 scale in combination with other indicators was carried out. A logistic regression analysis was performed, and two statistically significant variables were established (points on the GRACE 2.0 scale, KIM-1 value (pg/ml) in urine), a logistic regression equation was built: Y=-14.04813+(0.080005×points (GRACE 2.0 scale)+(0.0035426×KIM-1 value in urine). The variable “Y” was given the name “GRACE 2.0 – KIM-1”. According to the ROC-analysis it was determined that with the value of the indicator “GRACE 2.0 – KIM-1” more than -0.668390598 the risk of developing urgent UCС is higher: sensitivity 86.67% (95% CI 59.5–98.3), specificity 76.0% (95% CI 54.9–90.6), AUC=0.872 (95% CI 0.728–0.956; p<0.001). At the same time, the predictive value of the GRACE 2.0 – KIM-1 model increased by 12.5% compared to using only GRACE 2.0 scores.
Conclusion. The new model “GRACE 2.0 +– KIM-1” makes it possible to predict urgent UCC during the hospital period in patients with ACS in combination with OD.
Keywords: predictive model+, kidney injury molecule-1, KIM-1, oncological diseases, acute coronary syndrome, cardiovascular complications
About the Autors
Dmitry V. Pivovarov – Cand.Sci. (Med.), Physician, City Clinical Hospital No.38. Address: Nizhny Novgorod, Chernyshevsky str., 22; tel.: 8 (999) 121-78-66; e-mail:
pivovarov121094@yandex.ru. ORCID: https://orcid.org/0000-0002-6642-1364
Zinaida D. Mikhailova – Dr.Sci. (Med.), Assoc. Prof., Consulting Physician, City Clinical Hospital No.3. Address: Nizhny Novgorod, Chernyshevsky str., 22;
e-mail: zinaida.mihailowa@yandex.ru. ORCID: https://orcid.org/0000-0002-0926-6038
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