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Kontrast ilişkili akut böbrek hasarı ve Direct Bilirubin Düzeyleri Arasındaki İlişki

Year 2021, Volume: 5 Issue: 3, 244 - 249, 31.12.2021
https://doi.org/10.30565/medalanya.887847

Abstract

Amaç: Bu çalışmada akut koroner sendromlu (AKS) hastalarda antioksidatif, anti-inflamatuar ve antitrombotik etkileri olduğu bilinen bilirubin düzeyleri ile kontrast ile ilişkili akut böbrek hasarı (KI-ABH) arasındaki ilişkiyi araştırmayı amaçladık.

Yöntemler: 2017-2020 tarihleri arasında AKS tanısı ile perkütan anjioplasti yapılan, dışlama ve dahil edilme kriterlerine uyan ardışık 18 yaş üstü hastalar (n:514) retrospektif olarak tarandı. Hastaların yaş, cinsiyet, kronik hastalıkları, tam kan sayımı parametreleri, kontrast öncesi ve kontrast verildikten 48 saat sonraki biyokimyasal parametreleri kaydedildi. Kontrast ile ilişkili akut böbrek hasarı tanısı kontrast uygulandıktan 48 saat sonraki serum kreatininde bazal kreatinine göre %25 artış olarak tanımlandı.

Bulgular: Kadınlarda KI-ABH oranı daha yüksek bulundu (p=0.011). Hastalar KI-ABH pozitif ve negatif olmak üzere iki gruba ayrıldı. KI-ABH pozitif hasta grubunun yaş ortalaması anlamlı olarak daha yüksek (p= 0.04), Hemoglobin (p=0.007) ve direkt bilirubin (p=0.008) düzeyleri anlamlı olarak daha düşük bulundu. KI-ABH’nın bağımsız öngördürücüleri tespit etmek amacıyla yaptığımız istatistiksel analizi sonucunda direkt bilirubin (Beta: 0,051 OR (95% Cl 0,007/0,392 p=0,004) bir öngördürücü olarak bulundu. Direkt Bilirubin 0.065 değerinin %90 sensivite ve %91 spesivite ile KI-ABH ‘nı öngördürdüğü tespit edildi.

Sonuç: KI-ABH pozitif hasta grubunda direkt bilirubin düzeylerinin anlamlı olarak daha düşük olduğu ve Direkt Bilirubin 0.065 değerinin %90 sensivite ve %91 spesivite ile KI-ABH ‘nı öngördürdüğü bulunmuştur.

References

  • 1. Wong PC, Li Z, Guo J, Zhang A. Pathophysiology of contrast-induced nephropathy. Int J Cardiol. 2012;158(2):186-92. doi: 10.1016/j.ijcard.2011.06.115.
  • 2. Büyüklü M, Bakırcı EM, Değirmenci H, Ceyhun G, Topal E. Contrast-Induced Nephropathy: Management by Antioxidant Therapy. Koşuyolu Heart J. 2017;20(1):59-62. doi: 10.5578/khj.9543.
  • 3. Acar G, Akçay S, Aslan SM, Köroğlu M, Oyar O. Kontrast madde nefropatisi. S.D.Ü. Tıp Fak. Derg. 2005;12(3):62-8.
  • 4. Karabulut H, Gülay MŞ. Antioksidanlar. MAE Vet Fak Derg. 2016;1(1):65-76. doi: 10.24880/maeuvfd.260790.
  • 5. Xu C, Dong M, Deng Y, Zhang L, Deng F, Zhou J,et al. Relation of Direct, Indirect, and Total bilirubin to Adverse Long-term Outcomes Among Patients With Acute Coronary Syndrome. Am J Cardiol. 2019;123(8):1244-48. doi: 10.1016/j.amjcard.2019.01.019.
  • 6. Chintanaboina J, Haner MS, Sethi A, Patel N, Tanyous W, Lalos A, et al. Serum bilirubin as a prognostic marker in patients with acute decompensated heart failure. Korean J Intern Med. 2013;28(3):300-5. doi: 10.3904/kjim.2013.28.3.300.
  • 7. Boon AC, Bulmer AC, Coombes JS, Fassett RG. Circulating bilirubin and defense against kidney disease and cardiovascular mortality: mechanisms contributing to protection in clinical investigations. Am J Physiol Renal Physiol. 2014;307(2):123-36. doi: 10.1152/ajprenal.00039.2014.
  • 8. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020–35. doi: 10.1161/CIR.0b013e31826e1058.
  • 9. Meraz-Muno˜z A, Ron Wald R. Contrast-Associated Acute Kidney Injury: Will Clarifying Mechanisms Allay Anxiety? Clin J Am Soc Nephrol. 2020;15(9):1225-27, doi: 10.2215/CJN.11960720.
  • 10. Delgado Acosta F, Jiménez Gómez E, Bravo Rey I, Valverde Moyano R, de Asís Bravo-Rodriguez F, Oteros Fernández R. Contrast-induced nephropathy: A dilemma between loss of neurons or nephrons in the setting of endovascular treatment of acute ischemic stroke. Interv Neuroradiol. 2020;26(1):33-7. doi: 10.1177/1591019919883755.
  • 11. Aydemir B, Karadağ Sarı E. Antioksidanlar ve Büyüme Faktörleri ile İlişkisi. Kocatepe Veterinary Journal. 2009;2(2):56-60.
  • 12. Sen S, Chakraborty R. Oxidative Stress: Diagnostics, Prevention and Therapy. Chapter 1: In Saikat Sen and Raja Chakraborty, editors. In:The Role of Antioxidants in Human Health. American Chemical Society, 2011.p.1-37. doi: 10.1021/bk-2011-1083.ch001.
  • 13. Stocker R, Yamamoto Y, McDonagh AF, Glazer AN, Ames BN. Bilirubin is an antioxidant of possible physiological importance. Science. 1987;235(4792):1043-6. doi: 10.1126/science.3029864.
  • 14. Stocker R, Glazer AN, Ames BN. Antioxidant activity of albumin-bound bilirubin. Proc Natl Acad Sci U S A, 1987;84(16):5918-22. doi: 10.1073/pnas.84.16.5918.
  • 15. Kwak JY, Takeshige K, Cheung BS, Minakami S. Bilirubin inhibits the activation of superoxide-producing NADPH oxidase in a neutrophil cell-free system. Biochim Biophys Acta. 1991;1076(3):369-73. doi: 10.1016/0167-4838(91)90478-i.
  • 16. He Q, Jiang K, Xie L. The Relationship between Bilirubin Levels and Patients with Lupus Nephritis. Clin Lab. 2019;65(4). doi: 10.7754/Clin.Lab.2019.181125.
  • 17. Vítek L. Bilirubin and atherosclerotic diseases. Physiol Res. 2017;66(1):11-20. doi: 10.33549/physiolres.933581.
  • 18. Li WC, Mo LJ, Shi X, Lin ZY, Li YY, Yang Z et al. Antioxidant status of serum bilirubin, uric acid and albumin in pemphigus vulgaris. Clin Exp Dermatol. 2018;43(2):158-63. doi: 10.1111/ced.13289.
  • 19. Demir M, Demir C, Keçeoğlu S. The relationship between serum bilirubin concentration and coronary artery ectasia.Postepy Kardiol Interwencyjnej. 2015;11(3):202-5 doi: 10.5114/pwki.2015.54014
  • 20. Erkan A, Ekici B, Uğurlu M, Iş G, Seker R, Demirtaş S. et al. The role of bilirubin and its protective function against coronary heart disease. Herz. 2014;39(6):711-5. doi: 10.1007/s00059-013-3872-5.

The association between contrast associated acute kidney injury and direct bilirubin levels

Year 2021, Volume: 5 Issue: 3, 244 - 249, 31.12.2021
https://doi.org/10.30565/medalanya.887847

Abstract

Aim: In this study we aimed to association between bilirubin levels, which is known to have anti-oxidative, anti-inflammatory and anti-thrombotic effects, and contrast associated acute kidney injury (CA-AKI) in patients with acute coronary syndrome (ACS).

Methods: Between 2017-2020, consecutive patients over 18 years of age who applied percutaneous angioplasty with the ACS diagnosis and met the exclusion and inclusion criteria (n:514) were retrospectively screened. Age, gender, chronic diseases and complete blood count parameters of the cases were recorded. Biochemical parameters, before applying contrast and 48 hours after applying contrast, were recorded. A 25% increase in creatinine level measured 48 hours after contrast application compared to basal creatinine was defined as CA-AKI.

Results: CA-AKI rate was higher in females(p=0.011). In the CA-AKI positive patient group, the mean age was found significantly higher (p=0.04), hemoglobin (p=0.007), direct bilirubin (p=0.008) levels were found significantly lower. Direct bilirubin was found to be a predictor as a result of our statistical analysis to identify independent predictors of CA-AKI (Beta:0.051 OR 95% CI:0.007-0.392, p=0.004). It was found that the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.

Conclusion: It was observed that the direct bilirubin values were significantly lower in the CA-AKI positive patient group, and the direct bilirubin value of 0.065 predicted CA-AKI with 90% sensitivity and 91% specificity.

References

  • 1. Wong PC, Li Z, Guo J, Zhang A. Pathophysiology of contrast-induced nephropathy. Int J Cardiol. 2012;158(2):186-92. doi: 10.1016/j.ijcard.2011.06.115.
  • 2. Büyüklü M, Bakırcı EM, Değirmenci H, Ceyhun G, Topal E. Contrast-Induced Nephropathy: Management by Antioxidant Therapy. Koşuyolu Heart J. 2017;20(1):59-62. doi: 10.5578/khj.9543.
  • 3. Acar G, Akçay S, Aslan SM, Köroğlu M, Oyar O. Kontrast madde nefropatisi. S.D.Ü. Tıp Fak. Derg. 2005;12(3):62-8.
  • 4. Karabulut H, Gülay MŞ. Antioksidanlar. MAE Vet Fak Derg. 2016;1(1):65-76. doi: 10.24880/maeuvfd.260790.
  • 5. Xu C, Dong M, Deng Y, Zhang L, Deng F, Zhou J,et al. Relation of Direct, Indirect, and Total bilirubin to Adverse Long-term Outcomes Among Patients With Acute Coronary Syndrome. Am J Cardiol. 2019;123(8):1244-48. doi: 10.1016/j.amjcard.2019.01.019.
  • 6. Chintanaboina J, Haner MS, Sethi A, Patel N, Tanyous W, Lalos A, et al. Serum bilirubin as a prognostic marker in patients with acute decompensated heart failure. Korean J Intern Med. 2013;28(3):300-5. doi: 10.3904/kjim.2013.28.3.300.
  • 7. Boon AC, Bulmer AC, Coombes JS, Fassett RG. Circulating bilirubin and defense against kidney disease and cardiovascular mortality: mechanisms contributing to protection in clinical investigations. Am J Physiol Renal Physiol. 2014;307(2):123-36. doi: 10.1152/ajprenal.00039.2014.
  • 8. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. Circulation. 2012;126(16):2020–35. doi: 10.1161/CIR.0b013e31826e1058.
  • 9. Meraz-Muno˜z A, Ron Wald R. Contrast-Associated Acute Kidney Injury: Will Clarifying Mechanisms Allay Anxiety? Clin J Am Soc Nephrol. 2020;15(9):1225-27, doi: 10.2215/CJN.11960720.
  • 10. Delgado Acosta F, Jiménez Gómez E, Bravo Rey I, Valverde Moyano R, de Asís Bravo-Rodriguez F, Oteros Fernández R. Contrast-induced nephropathy: A dilemma between loss of neurons or nephrons in the setting of endovascular treatment of acute ischemic stroke. Interv Neuroradiol. 2020;26(1):33-7. doi: 10.1177/1591019919883755.
  • 11. Aydemir B, Karadağ Sarı E. Antioksidanlar ve Büyüme Faktörleri ile İlişkisi. Kocatepe Veterinary Journal. 2009;2(2):56-60.
  • 12. Sen S, Chakraborty R. Oxidative Stress: Diagnostics, Prevention and Therapy. Chapter 1: In Saikat Sen and Raja Chakraborty, editors. In:The Role of Antioxidants in Human Health. American Chemical Society, 2011.p.1-37. doi: 10.1021/bk-2011-1083.ch001.
  • 13. Stocker R, Yamamoto Y, McDonagh AF, Glazer AN, Ames BN. Bilirubin is an antioxidant of possible physiological importance. Science. 1987;235(4792):1043-6. doi: 10.1126/science.3029864.
  • 14. Stocker R, Glazer AN, Ames BN. Antioxidant activity of albumin-bound bilirubin. Proc Natl Acad Sci U S A, 1987;84(16):5918-22. doi: 10.1073/pnas.84.16.5918.
  • 15. Kwak JY, Takeshige K, Cheung BS, Minakami S. Bilirubin inhibits the activation of superoxide-producing NADPH oxidase in a neutrophil cell-free system. Biochim Biophys Acta. 1991;1076(3):369-73. doi: 10.1016/0167-4838(91)90478-i.
  • 16. He Q, Jiang K, Xie L. The Relationship between Bilirubin Levels and Patients with Lupus Nephritis. Clin Lab. 2019;65(4). doi: 10.7754/Clin.Lab.2019.181125.
  • 17. Vítek L. Bilirubin and atherosclerotic diseases. Physiol Res. 2017;66(1):11-20. doi: 10.33549/physiolres.933581.
  • 18. Li WC, Mo LJ, Shi X, Lin ZY, Li YY, Yang Z et al. Antioxidant status of serum bilirubin, uric acid and albumin in pemphigus vulgaris. Clin Exp Dermatol. 2018;43(2):158-63. doi: 10.1111/ced.13289.
  • 19. Demir M, Demir C, Keçeoğlu S. The relationship between serum bilirubin concentration and coronary artery ectasia.Postepy Kardiol Interwencyjnej. 2015;11(3):202-5 doi: 10.5114/pwki.2015.54014
  • 20. Erkan A, Ekici B, Uğurlu M, Iş G, Seker R, Demirtaş S. et al. The role of bilirubin and its protective function against coronary heart disease. Herz. 2014;39(6):711-5. doi: 10.1007/s00059-013-3872-5.
There are 20 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Research Article
Authors

Yasemin Kaya 0000-0001-7360-8090

Ahmet Kaya 0000-0001-9845-7938

Ahmet Karataş 0000-0001-9095-6054

Osman Bektaş

Mustafa Yenerçağ 0000-0002-0933-7852

Fatih Akkaya 0000-0002-9016-4986

Publication Date December 31, 2021
Submission Date February 27, 2021
Acceptance Date July 24, 2021
Published in Issue Year 2021 Volume: 5 Issue: 3

Cite

Vancouver Kaya Y, Kaya A, Karataş A, Bektaş O, Yenerçağ M, Akkaya F. The association between contrast associated acute kidney injury and direct bilirubin levels. Acta Med. Alanya. 2021;5(3):244-9.

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