BLOOD UREA NITROGEN-TO-LEFT VENTRICULAR EJECTION FRACTION RATIO AS A PREDICTOR FOR CONTRAST INDUCED NEPHROPATHY IN ACUTE CORONARY SYNDROME PATIENTS WHO WERE TREATED WITH PERCUTANEOUS CORONARY INTERVENTIO

Abstract

Background: Blood urea nitrogen (BUN) is an informative marker for both
renal and cardiac performance in addition to the neurohormonal activity
associated with their impairment. The aim of this study was to investigate the
predictive value of the blood urea nitrogen-to-left ventricular ejection fraction
ratio (BUN/EF) for the development of contrast induced nephropathy (CIN) in
patients with acute coronary syndrome (ACS) who underwent percutaneous
coronary intervention (PCI). A total of 100 patients with ACS who were planning
to attend PCI were enrolled in this observational study. The serum creatinine,
BUN and LVEF were measured on the same day before contrast medium
exposure. BUN/EF was determined for all patients. Serum creatinine was
measured after PCI (48–72 hours) to detect development of CIN.
Results: CIN had been developed in 14 cases (14%). Patients who developed
CIN were older, had higher frequency of diabetes mellitus, higher frequency of
hypertension and higher GENSINI Scores than those who had not develop
CIN. BUN values were greater in the CIN group than those in the non-CIN one
(22.8 ± 3 mg/dl vs 13.6±2.97 mg/dl, p<0.001). LVEF was lower in CIN group
than the non-CIN one. (37.6±1.6% vs 49.4±7.3%, p<0.001). BUN/EF was
greater in the CIN cases than the no-CIN cases (0.61±0.1 vs 0.3±0.1, p<0.001).
BUN/EF cutoff value >0.47 had sensitivity of 92.8% and specificity of 98.8%
to predict CIN in ACS patients after PCI (p< 0.001). BUN/EF was independent
risk factor in a multivariate logistic regression analysis for the development of
CIN (OR 469.6, confidence interval: 25.74-8568.5, p<0.001).
Conclusion: In addition to common risk factors of acute kidney injury initiated
by contrast exposure during coronary intervention, BUN/EF could predict
development of contrast induced nephropathy in patients with ACS who
underwent coronary intervention.