The Association of Serum Lactate Level with the Occurrence of Contrast-Induced Acute Kidney Injury and Long-Term Prognosis in Patients Undergoing Emergency Percutaneous Coronary Intervention

• Main Authors: Yan G, Wang D, Tang C, Ma G
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-07-01
• Series: International Journal of General Medicine
• Subjects: myocardial infarction; contrast media; acute kidney injury; lactate; percutaneous coronary intervention; prognosis
• Online Access: https://www.dovepress.com/the-association-of-serum-lactate-level-with-the-occurrence-of-contrast-peer-reviewed-fulltext-article-IJGM

Gaoliang Yan, Dong Wang, Chengchun Tang, Genshan Ma Department of Cardiology, Zhongda Hospital of Southeast University Medical School, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Genshan MaDepartment of Cardiology, Zhongda Hospital of Southeast University Medical School, No. 87 Dingjiaqiao, Gulou District, Nanjing, Jiangsu, 210009, People’s Republic of ChinaTel/Fax [phone]Email [e-mail]: The association of lactate and contrast-induced acute kidney injury (CI-AKI) has not been well established. This prospective study was planned to identify the effects of lactate level on the occurrence of CI-AKI and long-term prognosis with acute myocardial infarction (AMI) patients undergoing emergency percutaneous coronary intervention (PCI).Methods: A total of 280 patients with AMI who underwent emergency PCI were selected from March 2018 to March 2019. A receiver operating characteristic (ROC) curve was used to analyze the optimal cut-off value of lactate on predicting CI-AKI after PCI. A multivariable logistic regression model was used to explore the significant predictors that might affect the occurrence of CI-AKI after univariate analysis. The primary endpoints were clinical outcomes including events: a combined endpoint of major adverse cardiovascular events, re-hospitalization due to heart failure, and worsening renal function. The Cox regression model was further used to analyze the predictors of the long-term prognosis after PCI.Results: Among the 280 patients, 64 patients (22.9%) developed CI-AKI after emergency PCI procedure. Multivariable logistic regression analysis revealed that baseline lactate level was the independent risk factor for the development of CI-AKI (OR, 3.657; 95% CI, 2.237– 5.978; p< 0.001). The area under the ROC curve for predicting CI-AKI of lactate was 0.786, and the optimum cut-off point of lactate was 3.02 mmol/L, with sensitivity of 65.6% and specificity of 85.2%. The incidence of primary endpoints in the high lactate group (lactate ≥ 3.02mmol/L) was significantly increased compared with the control group [26.3% (42/160) vs 15.8% (19/120), χ2=4.430, p=0.035]. Cox regression analysis also confirmed high lactate was an independent predictor for primary endpoint outcomes at 1-year follow-up (HR, 1.916; 95% CI, 1.118– 3.285; p=0.018).Conclusion: Our study demonstrates that baseline high lactate levels may be associated with an increased risk of CI-AKI and are the important predictors of long-term poor cardiorenal outcomes in AMI patients undergoing emergency PCI.Keywords: myocardial infarction, contrast media, acute kidney injury, lactate, percutaneous coronary intervention, prognosis