The Relationship between Perioperative Serum Albumin and Contrast-induced Acute Kidney Injury in Patients after Percutaneous Coronary intervention

The Relationship between Perioperative Serum Albumin and Contrast-induced Acute Kidney Injury in Patients after Percutaneous Coronary intervention | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Relationship between Perioperative Serum Albumin and Contrast-induced Acute Kidney Injury in Patients after Percutaneous Coronary intervention Dong Wang, Gaoliang Yan, Yong Qiao, Renhua Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3906192/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Objective Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients undergoing percutaneous coronary intervention (PCI). Studies have shown that perioperative serum albumin levels may play a role in the occurrence of CI-AKI. This study aimed to investigate the effect of perioperative serum albumin (delta Albumin or &Alb) on the occurrence and long-term prognosis of CI-AKI after PCI. Methods A total of 959 patients who underwent PCI between January 2017 and January 2019 were selected for the study. Receiver operating characteristic curve was used to determine the optimal cut-off value of &Alb in predicting CI-AKI after PCI. Patients were divided into two groups based on the optimal cut-off value: the high &Alb group (&Alb ≥ 4.55 g/L) and the control group (&Alb < 4.55 g/L). The incidence of CI-AKI and major adverse cardiac events (MACE, including all-cause death, nonfatal myocardial infarction, and target vessel revascularization) was compared between the groups. Cox regression analysis was used to identify predictors of long-term prognosis after PCI. Results Of the 959 patients, 147(15.3%) developed CI-AKI after PCI. The CI-AKI group had a higher level of delta Albumin than the non-CI-AKI group ([6.14 (3.90–9.10) versus 3.48 (4.31–6.57), P < 0.01)]. The incidence of CI-AKI in the high & Alb group was significantly higher compared to the low group (23.6% versus 8.3%, P<0.01). After a 1-year follow-up, the incidence of MACE was significantly higher in the high delta Albumin group than in the low group (18.6% versus 14.5%, P = 0.030). Cox regression analysis confirmed that CI-AKI was an independent predictor of MACE at the 1-year follow-up (HR 1.43, 95% CI 1.04–1.96, P = 0.028). In addition, patients with low preoperative serum albumin had a significantly higher incidence of MACE than those with high preoperative serum albumin (23.2% versus 19.5%, P = 0.013). Conclusion In summary, baseline high delta Albumin levels are an independent risk factor for CI-AKI in patients after PCI. Furthermore, the occurrence of CI-AKI in the perioperative period is also an independent predictor of long-term prognosis after PCI. These findings highlight the importance of monitoring delta Albumin levels and taking steps to prevent CI-AKI in patients undergoing PCI. Contrast-induced acute kidney injury Perioperative Serum Albumin(&Albumin) Percutaneous coronary intervention Figures Figure 1 Figure 2 Figure 3 Introduction Percutaneous coronary intervention (PCI) is a common treatment for patients with coronary artery disease (CAD). Contrast-induced acute kidney injury (CI-AKI) is an acute decline in renal function following administration of iodinated contrast media [ 1 ] .In patients undergoing PCI, CI-AKI has become a significant complication that is closely linked to adverse clinical events. Contrast-induced nephropathy (CIN) is associated with increased rates of morbidity, mortality, and healthcare costs [ 2 , 3 ] . CI-AKI is defined as a 25% increase in serum creatinine levels or an absolute increase of more than 44.2 µmol/L following the administration of contrast media [ 4 , 5 ] . The pathogenesis of CI-AKI is complex, and the definite pathophysiologic basis is still not clear. Increased blood viscosity, reperfusion injury, direct toxicity of renal tubule cells, and long-term vasoconstriction are closely related to the occurrence of CI-AKI. CI-AKI increases the average length of hospital stay accelerates the occurrence of end-stage renal disease and seriously affects the clinical prognosis of PCI in patients with coronary heart disease, such as the occurrence of major adverse cardiovascular (MACE), cerebrovascular events (MACCE) and cardiac death (CVD) [ 6 ] . Albumin is the major protein of human plasma. Plasma albumin has many physiological properties: antioxidant, anti-inflammatory, anticoagulant, anti-platelet aggregation activity, etc. Low serum albumin concentrations may be caused by liver damage during acute inflammation or increased renal excretion, malnutrition, increased catabolism, intestinal losses, severe volume overload, and escape to interstitial spaces [ 7 ] . Low serum albumin is independently associated with the development of various diseases, such as severe forms of myocardial infarction (MI), coronary artery disease (CAD), stroke, CI-AKI, hip fracture, and malignancy [ 8 – 11 ] . As indicators of nutritional status and inflammatory factors, perioperative albumin levels and postoperative effects were explored. Several previous studies have shown that perioperative albumin levels are significantly associated with postoperative complications in patients with malignancies including colorectal cancer, gastric cancer, and lung cancer and non-cancer patients (3–6). [ 12 – 15 ] Similarly, the relationship between perioperative albumin and adverse outcomes after abdominal surgery was discussed [ 16 , 17 ] . However, there are few studies on the relationship between perioperative serum albumin (&Albumin) with the occurrence of CI-AKI in patients with coronary heart disease after PCI. The present study was designed to examine the correlation between &Albumin and CI-AKI in patients who underwent PCI. Methods Study Population Patients who received their first PCI treatment between January 2017 and January 2019 were selected as potential participants in the Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University (see Fig. 1 ). Inclusion criteria were as follows: adult patients aged ≥ 18 years and patients who agreed to participate in the present study. Exclusion criteria were as follows: (1) Complicated with hypotension or cardiogenic shock; (2) History of allergy to iodine or iodine contrast agent; (3) Chronic renal insufficiency stage 5 or maintenance hemodialysis /peritoneal dialysis patients; (4) CT scan, MRI scan, angiography and other application of contrast agent examination within two weeks before inclusion; imaging examination using other contrast agents is expected to be performed during the study period (except elective PCI 1 week later, the same contrast agent is required); (5) Acute kidney injury or the use of nephrotoxic drugs in the past two weeks; (6) Inflammatory diseases, autoimmune diseases, liver insufficiency, thyroid dysfunction, malignant tumors, infectious diseases; (7) Incomplete collection of patient medical records, especially the lack of renal function evaluation indicators 48 to 72 hours after PCI. Data Collection The patient's medical history, symptoms, signs, examination, and test results were recorded in detail. Data included age, sex, smoking, hypertension, diabetes, atrial fibrillation, stroke, and body mass index at admission. Left ventricular ejection fraction (LVEF), blood routine examination, biochemistry, basic cardiovascular medication information, and volume of contrast media were recorded. Based on the coronary angiography results, the severity of coronary artery disease was evaluated by the Gensini score [ 18 ] , and multivessel disease was defined as ≥ 50% diameter stenosis in at least 2 major coronary arteries. Diagnostic Criteria of Coronary heart disease (CHD) The diagnostic criteria of CHD depend on the typical angina pectoralis symptoms, ECG changes, and the determination of myocardial injury markers. Coronary angiography is the gold standard for diagnosis, and coronary CTA can also be used for preliminary screening of coronary heart disease. (1) Chest pain symptoms: most of them are crushing pain located in retrosternal and precordial areas, which are related to activity and emotional agitation. According to different types, the duration is different, and the degree of relief of nitrate drugs is different. (2) ECG manifestations: The ECG manifestations of UA and NSTEMI are transient ST segment (elevated or lowered) and T wave (flat or inverted) changes during the onset of chest pain. The ECG of STEMI can show ST-segment elevation, wide and deep Q wave, T wave inversion, and so on. (3) Myocardial injury markers: for patients with STEMI and NSTEMI, myocardial injury markers are elevated at the corresponding time. However, the markers of myocardial injury in UA patients were normal or slightly elevated. (4): Coronary angiography: Coronary angiography is the gold standard for diagnosis. And coronary CTA can also be used for preliminary screening of coronary heart disease. Clinical Medication and CI-AKI Prevention Strategy All patients received loading doses of double anti-platelet aggregation drugs (aspirin 300mg and clopidogrel 300mg, or ticagrelor 180mg) before surgery, and dual antiplatelet therapy (aspirin 100mg·d − 1 and clopidogrel 75mg·d − 1 or ticagrelor 180mg·d − 1 ) continued for at least 12 months. Use of other medications (𝛽-receptor blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, nitrate esters, calcium antagonist, and statins) were left to the discretion of individual cardiologists. Adequate hydration remains the main means of CI-AKI prevention, at present the best hydration solution is still inconclusive, sodium chloride solution (NaCl) is widely used hydration solution. Because the study population includes several patients with cardiac insufficiency, it is up to the clinician to decide whether to hydrate according to the situation of the patients. In case of hydration, the following requirements should be followed: 3–12 hours before surgery and 6–24 hours after surgery, isotonic crystal solution should be given intravenously at a rate of 1.0ml·kg −1 ·h −1 -1.5ml·kg −1· h −1 . The use of nephrotoxic drugs during the study (including large-dose loop diuretics, nonsteroidal anti-inflammatory drugs other than aspirin, aminoglycosides, amphotericin B, and traditional Chinese medicine containing aristolochic acid, etc.) should be avoided. Follow-Up The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization (PCI or bypass surgery). Statistical Analysis Statistical analysis of data was performed using SPSS 27.0 software. Measurement data with a normal distribution were expressed as the mean (x) ± Standard deviation (s), and a comparison between the two groups was performed by an independent sample t-test. Measurement data with skewed distribution were expressed as M (Q1, Q3), and the Mann-Whitney U test was used for comparison between the two groups. Enumeration data were expressed as a rate or constituent ratio, and comparison between the two groups was performed by the Chi-square test or Fisher's exact probability method. Multivariate logistic regression analysis was employed to analyze the correlation between &Albumin and CI-AKI. The receiver operating characteristic (ROC) curve was used to analyze the optimal cutoff value and area under the curve (AUC) of &Albumin in predicting CI-AKI after PCI. Survival analysis was performed using Kaplan-Meier survival analysis. The log-rank test was used for comparison between the two groups. Multivariate Cox regression was used to analyze the predictors of MACE in CHD patients during 1-year follow-up after PCI. P < 0.05 was considered statistically significant using a two-tailed test. Results Baseline Characteristics A total of 959 patients undergoing PCI were included in this study. The average age was 67 ± 10.5 years [range:60–75]. Among these patients, 603 cases (62.9%) were male, 703 cases (73.3%) had hypertension, and 316 cases (33.0%) had diabetes, among which 147 had suffered an attack of CI-AKI. The incidence of CI-AKI in patients with PCI was 15.3% (147/959). Patients were divided into 2 groups based on the optimal cut-off value of &Albumin: high&Alb group (&Alb ≥ 4.55 g/L, a total of 440 cases) and a control group (&Alb < 4.55 g/L, a total of 519 cases). The incidence of CI-AKI in the high &Albumin group was significantly higher compared to that in the low group [23.6% (104/440) versus 8.3% (43/519), P<0.01]. The comparison of clinical data between the high &Albumin group and the low group is shown in Table 1 . In the high &Albumin group more males, older, had a higher proportion of smoking and had a higher proportion of hypertension (P<0.05). Table 1 Baseline characteristics of the two groups Variables High & Alb group(n = 440) Low & Alb group(n = 519) P value Male, n (%) 293 (66.6%) 310 (59.7%) 0.029 Age(years) 68 ± 10 66 ± 11 0.023 BMI (kg·m 2 − 1 ) 24.89 ± 3.2 25 ± 3.4 0.549 Systolic BP (mmHg) 135.50 ± 18.95 137.97 ± 21.03 0.053 Diastolic BP (mmHg) 76.75 ± 12.74 76.35 ± 12.98 0.713 Smoking, n (%) 136 (30.9%) 113 (21.8%) <0.01 Hypertension, n (%) 308 (70.0%) 395 (76.1%) 0.033 Diabetes, n (%) 145 (33.0%) 171 (32.9%) 0.998 Atrial fibrillation, n (%) 46 (10.5%) 36 (6.9%) 0.052 LVEF (%) 46 (10.5%) 36 (6.9%) 0.375 Stroke, n (%) 93 (21.1%) 123 (23.7%) 0.344 Medication, n (%) Aspirin 433 (98.4%) 506 (97.5%) 0.324 ACEI/ARB 240 (54.5%) 295 (56.8%) 0.476 β-blocker 347 (78.9%) 403 (77.6%) 0.650 Statins 401 (99.8%) 381 (99.7%) 0.662 Angiography Gensini score 64.7 ± 37.52 66.2 ± 38.36 0.388 Contrast dose (mL) 105.6 ± 22.31 109.3 ± 20.26 0.664 Vessels, n 2.16 ± 0.808 2.20 ± 0.789 0.281 Multi-vessel, n (%) 184 (41.8%) 225 (43.4%) 0.284 Stents, n 1.59 ± 0.708 1.50 ± 0.666 0.103 Multi-stent, n (%) 159 (36.1%) 173 (33.3%) 0.364 hydration, n (%) 104 (68.5) 338 (65.1) 0.386 CI-AKI, n (%) 104 (23.6%) 43 (8.3%) <0.01 Note: Data are presented as the mean ± Standard deviation, mean (25% quartile-75% quartile) or n (%). Abbreviations: BMI, body mass index; BP, blood pressure; LVEF, left ventricular ejection fraction; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI-AKI, contrast-induced acute kidney injury; &Albumin, Perioperative Serum Albumin. A comparison of the laboratory parameters between the 2 groups is shown in Table 2 . Patients in the high & Albumin group had a significantly higher baseline platelet count, indirect bilirubin, and uric acid levels than those in the low group (P < 0.05). However, patients in the high & Albumin group showed a significantly lower level of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and HDL-C compared to patients in the low group (P < 0.05). Table 2 Baseline laboratory characteristics of the two groups Variables High & Alb group(n = 440) Low & Alb group(n = 519) P value RBC (×10 12 /L) 4.48 ± 0.55 4.45 ± 0.58 0.672 WBC (×10 9 · /L ) 7.05 ± 2.42 6.98 ± 2.23 0.470 HGB (g/L) 137.38 ± 16.30 135.35 ± 17.90 0.068 PLT (×10 9 /L) 213.77 ± 67.30 195.8 ± 58.87 <0.01 NEU (×10 9 /L) 4.63 ± 1.61 4.71 ± 1.92 0.435 LYM (×10 9 /L) 1.71 ± 0.75 1.67 ± 0.61 0.357 MON (×10 9 /L) 0.42 ± 0.246 0.41 ± 0.178 0.203 DBIL (µmol/L) 3.27 ± 2.14 3.89 ± 2.99 0.318 IBIL (µmol/L) 9.29 ± 4.46 8.61 ± 4.29 0.016 ALT (U/L) 26.15 ± 23.62 26.17 ± 20.66 0.988 AST (U/L) 26.95 ± 25.62 27.46 ± 21.33 0.740 Glucose (mmol/L) 6.64 ± 2.52 7.10 ± 2.98 0.011 SCr (µmol/L) 84.55 ± 34.49 81.39 ± 23.39 0.102 Uric acid (µmol/L) 375.01 ± 112.07 358.70 ± 100.67 0.019 Triglyceride (mmol/L) 1.67 ± 0.97 1.84 ± 1.61 0.023 TC (mmol/L) 4.28 ± 1.07 4.62 ± 1.24 <0.01 HDL-C (mmol/L) 1.09 ± 0.24 1.15 ± 0.34 0.004 LDL-C (mmol/L) 2.60 ± 0.89 2.84 ± 0.99 <0.01 Preoperative albumin (g/L) 39.53 ± 3.96 39.43 ± 4.31 0.705 Postoperative albumin (g/L) 31.82 ± 4.53 38.77 ± 5.47 <0.01 Note: Data are the mean ± Standard deviation, mean (25% quartile-75% quartile) or n (%). Abbreviations: RBC, red blood cells; WBC, white blood cells; HGB, hemoglobin; PLT, platelet count; NEU, neutrophil count; LYM, lymphocyte count; MON, monocyte count; DBIL, direct bilirubin; IBIL, indirect bilirubin; ALT, alanine aminotransferase; AST, alanine aminotransferase; SCr, Serum creatinine; TC, Total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; & Albumin, Perioperative Serum Albumin. Correlations between the &Albumin and CI-AKI A Pearson correlation analysis showed that the &Albumin was linearly correlated with CI-AKI (r = 0.212, P < 0.001). Moreover, ROC curve analysis and AUC values showed (Fig. 2 , Table 3 ) that the AUC value of & Albumin for CI-AKI after PCI was 0.675, [95% confidence interval (CI): 0.627–0.724, P<0.001], the best cut-off value was 4.55 g/L, the sensitivity was70.7%, and the specificity was 58.5%. Postoperative albumin for CI-AKI after PCI was 0.659, [95% confidence interval (CI): 0.626–0.723, P<0.001], the best cut-off value was 4.55g/L, the sensitivity was70.7%, and the specificity was 58.5%. Table 3 Area under curve between Variables Variables AUC Cut-off value Sensitivity Specificity P value 95% CI & Alb 0.675 4.55 0.707 0.585 <0.01 0.626–0.723 Preoperative albumin (g/L) 0.546 39.15 0.565 0.56 0.075 0.495–0.597 Postoperative albumin g/L) 0.659 34.25 0.646 0.616 <0.01 0.626–0.723 Note: AUC = area under curve; 95%CI = 95% confidence interval; CI-AKI, contrast-induced acute kidney injury. & Albumin, Perioperative Serum Albumin. To identify independent predictors of CI-AKI, multivariate logistic regression analysis revealed that a high & Albumin [odds ratio (OR) 2.495, 95% CI: 1.277–4.874, P = 0.007], males (OR 0.616, 95% CI: 0.389–0.976, P = 0.039), a serum creatinine level (OR 1.021, 95% CI: 1.015–1.027, P < 0.001) and triglyceride level (OR 0.775, 95% CI: 0.627–0.958, P = 0.019), Postoperative albumin level l (OR 0.911, 95% CI: 0.883–0.940, P < 0.001), hypoproteinemia after surgery (OR 2.497, 95% CI: 1.361–4.582, P = 0.003), and triglyceride level (OR 0.775, 95% CI: 0.627–0.958, P = 0.019) were independent risk factors for the development of CI-AKI. DeLong's test showed that the diagnostic efficiency of preoperative albumin level was worse than that of postoperative albumin level, with statistical significance (P<0.01). The diagnostic efficiency of preoperative albumin level was lower than that of & Albumin, and the results were statistically significant P<0.01). Diagnostic efficiency of postoperative albumin level was worse than that of & Albumin, and the result was not statistically significant (P = 0.417). Analysis of & Albumin and long-term clinical outcomes All patients completed a 1-year clinical follow-up. Patients with a high & Albumin (≥ 4.55g/L) had worse clinical outcomes, with a greater incidence of primary endpoints [18.6% (82/440) vs14.5% (75/519), P = 0.022]. No significant differences were found in all-cause death (1.3% vs 0.1%, P = 0.087), and non-fatal myocardial infarction (4.6% vs 3.4%, P = 0.342). However, the incidence of target vascular revascularization (16.6% vs 10.2%, P = 0.004) was significantly increased in the high & Albumin group. Kaplan-Meier curves are shown in Fig. 3 . Evaluation of the prognostic performance of & Albumin and CI-AKI for MACE To evaluate the independent predictors of MACE in patients at 1-year follow-up, Cox regression analysis was performed, which showed that CI-AKI was an independent predictor for primary endpoint outcomes at 1-year follow-up [hazard ratio (HR) 1.521, 95% CI:1.036–2.233, P = 0.032]. Another variable showing an independent prognostic impact was multivessel disease (HR3.145, 95% CI:1.839–5.377, P <0.01). The results of Cox regression analysis are presented in Table 3 . Discussion Contrast agents are commonly used in imaging enhancement, especially in computed tomography and magnetic resonance imaging, or in coronary angiography (CAG) and percutaneous coronary intervention (PCI) [ 2 ] .In patients undergoing PCI, contrast-induced acute kidney injury (CI-AKI) has become a serious complication that is closely related to clinical adverse events, Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality rates [ 3 , 4 ] . Clinical and surgical prognosis of patients with coronary heart disease (CHD) is significantly improved by the use of coronary stenting. However, the incidence of CI-AKI is increasing year by year and has become one of the critical complications in the process of coronary revascularization. Our results showed that CI-AKI increases the occurrence of MACE, and seriously affects the clinical prognosis of patients after PCI. The pathogenesis of CI-AKI is complex, and the definite pathophysiologic basis is still not clear. At present, it is primarily put down to intrarenal vasoconstriction, production of reactive oxygen species and direct tubular injury.After intravascular injection of contrast media, it can induce a variety of factors to lead to renal vasoconstriction, including antidiuretic hormone (ADH), adenosine, endothelin-1 (ET-1), etc [ 19 ] ,they transiently cause an increase in renal blood arterial flow, followed by persistent severe contraction, eventually causing renal hypoperfusion and renal medullary ischemia and hypoxia [ 20 ] . Oxidative stress injury may also be one of the pathophysiological mechanisms of CI-AKI. The contrast agent can cause a decrease in blood supply in the renal medulla, resulting in the imbalance of metabolic demand and blood supply in the crude ascending branch of the myelin loop of the outer medulla layer, resulting in the production of superoxide, resulting in oxidative necrosis of the renal tubules [ 21 , 22 ] . Direct cytotoxicity of contrast agents in vascular endothelial cells results in increased endothelin and adenosine, decreased nitric oxide and prostaglandins [ 23 ] , and increased fluid viscosity in vascular and tubular cells. Although the majority of contrast media-induced kidney damage can return to normal levels within 1–4 weeks, multiple risk factors such as CKD and hypotension may lead to loss of functional nephron and impairment of renal function. As the dose of contrast medium increases, the regenerative capacity of tubular epithelial cells is destroyed, and some renal units may eventually become fibrosis and permanently lose function [ 24 , 25 ] .Contrast agents are allergens that cause systemic allergic reactions and renal immune inflammatory responses and are involved in the mechanisms of CI-AKI [ 22 , 26 ] .Systemic inflammation can cause the kidney to be more susceptible to local inflammation caused by iodinated contrast agents after angiography, thereby further promoting the occurrence of contrast-induced acute kidney injury. Vascular remodeling induced by oxidative stress effect and secondary inflammatory response is the core link of the event chain in coronary artery disease, in which endothelial dysfunction and smooth muscle phenotype conversion imbalance are two key nodes of vascular remodeling. Atherosclerosis is related to many susceptibility factors to CI-AKI and leads to the release of many reactive metabolites that can cause hemodynamic and inflammatory changes that worsen renal blood flow. As one of the routine examination items of hospitalized patients, serum albumin can help the body bind and transport endogenous and exogenous substances, maintain stable colloid osmotic pressure in the blood, remove free radicals harmful to the animal body, and inhibit platelet aggregation to achieve anticoagulant effect [ 27 ] .In the presence of low serum albumin, oxidatively deformed LDL is cytotoxic and strongly atherogenic [ 28 ] .In contrast, low expression of albumin increases blood viscosity, which in turn promotes the progression of CHD and even disrupts normal vascular endothelial function, further leading to impaired cardiac function. As indicators of nutritional status and inflammatory factors, perioperative albumin levels and postoperative effects were explored. Several previous studies have shown that perioperative albumin levels are significantly associated with postoperative complications in patients with malignancies including colorectal cancer, gastric cancer, and lung cancer and non-cancer patients [ 12 – 15 ] .Similarly, the relationship between perioperative albumin and adverse outcomes after abdominal surgery was discussed [ 15 , 16 ] . In this study, we found that perioperative albumin decreased (& albumin ≥ 4.55 g · L − 1 ) was an independent risk factor for CI-AKI and an important predictor of MACE 1 year after PCI in patients with coronary heart disease; & albumin ≥ 4.55 g · L − 1 could not only be used for the early identification of CI-AKI in the short term after PCI in patients, but also had a high predictive value for MACE 1 year after PCI. The incidence of CI-AKI in patients after PCI was found to be as high as 15.3%% in this study, making early identification of patients at risk for CI-AKI extremely important. In terms of CI-AKI, our findings are largely consistent with the results from a clinical study in which890 ACS patients were enrolled who underwent primary PCI, thereby indicating that lower serum albumin levels may predict CI-AKI development after primary PCI in ACS patients [ 6 ] .Moreover, the multivariate logistic regression analysis revealed that a high & Albumin [ (OR) 2.495, 95% CI: 1.277–4.874, P = 0.007] can predict CI-AKI development after primary PCI in CHD patients; Receiver operating characteristic curve analysis shows that the & Albumin level is an accurate predictor for the development of CI-AKI; the area under the curve was 0.675 for the baseline & Albumin level (95% CI: 0.627–0.724, P<0.001). The optimum cutoff point of & Albumin was 4.55 g/L, with a sensitivity of 70.7% and a specificity of 58.5%. These explain that the decrease of perioperative serum albumin can be used as a predictor of CI-AKI after PCI, which helps to identify patients undergoing PCI and high-risk patients with CI-AKI early, thus providing a basis for the development of protective measures. More samples and studies are needed to further prove this point. By comparing the baseline data of the two groups of patients, we also found that the patients in the high & albumin group were older and had a lower body mass index, suggesting that the postoperative albumin reduction was more obvious in the older patients, this may be associated with low food intake and poor nutritional status in the elderly. Serum albumin levels are mostly considered to reflect the status of malnutrition and chronic diseases, and the low level of serum albumin will cause a decrease in plasma colloid osmotic pressure, a large amount of fluid retention in the interstitial space, a corresponding reduction in effective circulating blood volume, promote microcirculatory disturbances, lead to hypoperfusion of vital organs, and may produce multiple organ dysfunction. It suggests that we pay more attention to the nutritional status of elderly patients before surgery. In addition, at 1-year follow-up, the incidence of MACE was higher in the high & Albumin group than in the low group. Cox regression analysis showed that CI-AKI was an independent predictor of the primary endpoint outcome, suggesting that CI-AKI was associated with an increase in MACE in CHD patients. CI-AKI is strongly associated with an increased adverse prognosis. The results of this study highlight the importance of CI-AKI in MACE [29] occurrences. This study has some limitations. Firstly, all cases in the study come from one hospital, so the sample size is small, and there is inevitable selection bias, which needs to be further demonstrated by data with a larger sample size. Furthermore, many factors can affect albumin levels and/or the incidence of myocardial infarction. Although many disease states that may affect the final results are excluded from this study and multi-factor adjustment are performed to reduce bias, there may still be other confounding factors that have not been adjusted for enrollment that has affected the results. Conclusion Serum albumin levels measured pre and post albumin concentration is helpful to identify CI-AKI after PCI and predict long-term prognosis. According to the level of perioperative albumin reduction, clinicians can be encouraged to carry out additional CI-AKI prevention and close follow-up of high-risk patients, to ultimately improve the prognosis of patients, which have certain clinical significance and application value. Declarations Acknowledgments This study was supported by the open research fund of Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments，Southeast University (No. KF202304). We are grateful to the staff in the Biobank of Zhongda Hospital Affiliated with Southeast University for technical assistance. Ethics Approval and Consent to Participate This study was conducted with approval from the Ethics Committee of Zhongda Hospital, Southeast University Medical School. This study was conducted following the Declaration of Helsinki. Written informed consent was obtained from all participants. Disclosure The authors declare that they have no competing interests concerning this paper. Data Availability Statement Data related to this manuscript can be made available from the corresponding author upon reasonable request. References Kooiman J, van de Peppel W R, Sijpkens Y W, et al. No increase in Kidney Injury Molecule-1 and Neutrophil Gelatinase-Associated Lipocalin excretion following intravenous contrast enhanced-CT[J]. Eur Radiol, 2015,25(7):1926-1934. Ali Z A, Karimi G K, Nazif T, et al. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study[J]. Eur Heart J, 2016,37(40):3090-3095. Rudnick M R, Leonberg-Yoo A K, Litt H I, et al. The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?[J]. Am J Kidney Dis, 2020,75(1):105-113. van der Molen A J, Reimer P, Dekkers I A, et al. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines[J]. Eur Radiol, 2018,28(7):2845-2855. Andreis A, Budano C, Levis M, et al. Contrast-induced kidney injury: how does it affect long-term cardiac mortality?[J]. J Cardiovasc Med (Hagerstown), 2017,18(11):908-915. Levitt D G, Levitt M D. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements[J]. Int J Gen Med, 2016,9:229-255. Djousse L, Rothman K J, Cupples L A. Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham Offspring Study[J]. Circulation, 2002,106(23):2919-2924. Wang M, Liu J, Ma C, et al. Synergistic association of serum albumin and globulin with coronary heart disease[J]. J Atheroscler Thromb, 2012,19(7):619-632. Gillum RF I D M D. Relation between serum albumin concentration and stroke incidence and death: the NHANES I Epidemiologic Follow-up Study.[J]. Am J Epidemiol, 1994. Murat S N, Kurtul A, Yarlioglues M. Impact of Serum Albumin Levels on Contrast-Induced Acute Kidney Injury in Patients With Acute Coronary Syndromes Treated With Percutaneous Coronary Intervention[J]. Angiology, 2015,66(8):732-737. Hardt J, Pilz L, Magdeburg J, et al. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection[J]. Int J Colorectal Dis, 2017,32(10):1439-1446. Uppal S, Al-Niaimi A, Rice L W, et al. Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies[J]. Gynecol Oncol, 2013,131(2):416-422. Li P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study[J]. J Thorac Dis, 2018,10(10):5755-5763. Bohl D D, Shen M R, Hannon C P, et al. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture[J]. J Bone Joint Surg Am, 2017,99(24):2110-2118. Labgaa I, Joliat G R, Kefleyesus A, et al. Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre[J]. BMJ Open, 2017,7(4):e13966. Issangya C E, Msuya D, Chilonga K, et al. Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania[J]. BMC Surg, 2020,20(1):155. Gensini G G. A more meaningful scoring system for determining the severity of coronary heart disease[J]. Am J Cardiol, 1983,51(3):606. Lee S E, Jang J E, Kim H S, et al. Mesenchymal stem cells prevent the progression of diabetic nephropathy by improving mitochondrial function in tubular epithelial cells[J]. Experimental & Molecular Medicine, 2019,51(7):1-14. Chang C F, Lin C C. Current concepts of contrast-induced nephropathy: a brief review[J]. J Chin Med Assoc, 2013,76(12):673-681. Hossain M A, Costanzo E, Cosentino J, et al. Contrast-induced nephropathy: Pathophysiology, risk factors, and prevention[J]. Saudi J Kidney Dis Transpl, 2018,29(1):1-9. Liu L Y, Liu Y, Wu M Y, et al. Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis[J]. Drug Des Devel Ther, 2018,12:437-444. Dugbartey G J, Redington A N. Prevention of contrast-induced nephropathy by limb ischemic preconditioning: underlying mechanisms and clinical effects[J]. Am J Physiol Renal Physiol, 2018,314(3):F319-F328. Pisani A, Riccio E, Andreucci M, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy[J]. Biomed Res Int, 2013,2013:868321. Sun G, Chen J Y, Liu Y. Contrast-Induced Nephropathy: Further Investigations About Risk Factors Are Required[J]. Angiology, 2019,70(8):784-785. Abizaid A S, Clark C E, Mintz G S, et al. Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency[J]. Am J Cardiol, 1999,83(2):260-263, A5. Yingxia Zhang Y Z. Function and application of serum albumin[J]. Journal of Hainan University (Natural Science Edition), 2007(03):315-320. Tsirpanlis G, Bagos P, Ioannou D, et al. Exploring inflammation in hemodialysis patients: persistent and superimposed inflammation. A longitudinal study[J]. Kidney Blood Press Res, 2004,27(2):63-70. Liu T, Lee S R. Poor Prognosis of Contrast-Induced Nephropathy during Long Term Follow Up[J]. Chonnam Med J, 2021,57(3):197-203. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Mar, 2024 Reviews received at journal 04 Feb, 2024 Reviewers agreed at journal 03 Feb, 2024 Reviewers invited by journal 03 Feb, 2024 Editor assigned by journal 03 Feb, 2024 Editor invited by journal 03 Feb, 2024 Submission checks completed at journal 03 Feb, 2024 First submitted to journal 28 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3906192","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":271223762,"identity":"90616089-1bc1-414b-b67d-a5d940862095","order_by":0,"name":"Dong Wang","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"","lastName":"Wang","suffix":""},{"id":271223763,"identity":"1baa4cf3-dfba-468c-92b2-7d8d89d470e6","order_by":1,"name":"Gaoliang Yan","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Gaoliang","middleName":"","lastName":"Yan","suffix":""},{"id":271223764,"identity":"149bdde1-9b70-4618-a0a9-437efb2d7fdb","order_by":2,"name":"Yong Qiao","email":"","orcid":"","institution":"Zhongda Hospital, Southeast University","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Qiao","suffix":""},{"id":271223765,"identity":"ca907ff4-46d8-415a-b371-4512fcd6fc34","order_by":3,"name":"Renhua Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABB0lEQVRIiWNgGAWjYPCCAwwMzMwHH/+oOADhPiBKCztbsjHDmQMMPCBuAlFa+HnMpBnbIFoY8GmRn5F77MPHHXcS+5t5jI0L592Rsxc7/BBoi52cbgN2LQY38pJnzjzzLHHGYbbCxzO3PTPmkU4zAGpJNjY7gEOLRI4xM2/b4cSGw8ybDXi3HU7skU4AaTmQuA2HFvkZQC1/gVrmH2Ywk+CdA9KS/gGvFoYbQC2MQC0bDrOYSfM2gLTk4LfF4MwbY8betsPGGw+zJRvOOHbYmOd2TsGBBAPcfpFvzzFm+Nl2WHbe+cMHH3yoOSzHPjt984cPFXZyuLTgAgakKR8Fo2AUjIJRgAoA8wRpLySrHt4AAAAASUVORK5CYII=","orcid":"","institution":"Southeast University","correspondingAuthor":true,"prefix":"","firstName":"Renhua","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2024-01-28 15:35:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3906192/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3906192/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":50749668,"identity":"a403c29f-3181-4da1-8e7e-ab8296a0a663","added_by":"auto","created_at":"2024-02-06 17:26:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":508516,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow diagram of patient selection\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3906192/v1/6f0e33ee4029e29d595628ab.png"},{"id":50749670,"identity":"ed9fe2a3-faed-4ef5-9a1e-67a169800f46","added_by":"auto","created_at":"2024-02-06 17:26:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":375331,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve of various serum albumin predicting CI-AKI\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-3906192/v1/4442af7134311b0ad8d00a7f.png"},{"id":50749669,"identity":"18433cee-4e90-4894-a85b-5e3b62b1b3a9","added_by":"auto","created_at":"2024-02-06 17:26:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":186414,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Kaplan-Meier survival analysis curve of clinical outcomes after 1-year follow-up among the 2 groups.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: Blue line, low \u0026amp;Albumin group; red line, high \u0026amp;Albumin group.\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-3906192/v1/865c83f829cf0460df084bc9.png"},{"id":50751136,"identity":"e68e3e20-f315-41b0-ba41-662dc9ff6411","added_by":"auto","created_at":"2024-02-06 17:34:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1104060,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3906192/v1/1d54b196-c72b-4f93-bd73-2b327d3000de.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Relationship between Perioperative Serum Albumin and Contrast-induced Acute Kidney Injury in Patients after Percutaneous Coronary intervention","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePercutaneous coronary intervention (PCI) is a common treatment for patients with coronary artery disease (CAD). Contrast-induced acute kidney injury (CI-AKI) is an acute decline in renal function following administration of iodinated contrast media\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.In patients undergoing PCI, CI-AKI has become a significant complication that is closely linked to adverse clinical events. Contrast-induced nephropathy (CIN) is associated with increased rates of morbidity, mortality, and healthcare costs\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. CI-AKI is defined as a 25% increase in serum creatinine levels or an absolute increase of more than 44.2 \u0026micro;mol/L following the administration of contrast media\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. The pathogenesis of CI-AKI is complex, and the definite pathophysiologic basis is still not clear. Increased blood viscosity, reperfusion injury, direct toxicity of renal tubule cells, and long-term vasoconstriction are closely related to the occurrence of CI-AKI. CI-AKI increases the average length of hospital stay accelerates the occurrence of end-stage renal disease and seriously affects the clinical prognosis of PCI in patients with coronary heart disease, such as the occurrence of major adverse cardiovascular (MACE), cerebrovascular events (MACCE) and cardiac death (CVD)\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlbumin is the major protein of human plasma. Plasma albumin has many physiological properties: antioxidant, anti-inflammatory, anticoagulant, anti-platelet aggregation activity, etc. Low serum albumin concentrations may be caused by liver damage during acute inflammation or increased renal excretion, malnutrition, increased catabolism, intestinal losses, severe volume overload, and escape to interstitial spaces\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Low serum albumin is independently associated with the development of various diseases, such as severe forms of myocardial infarction (MI), coronary artery disease (CAD), stroke, CI-AKI, hip fracture, and malignancy \u003csup\u003e[\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. As indicators of nutritional status and inflammatory factors, perioperative albumin levels and postoperative effects were explored. Several previous studies have shown that perioperative albumin levels are significantly associated with postoperative complications in patients with malignancies including colorectal cancer, gastric cancer, and lung cancer and non-cancer patients (3\u0026ndash;6). \u003csup\u003e[\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003eSimilarly, the relationship between perioperative albumin and adverse outcomes after abdominal surgery was discussed\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, there are few studies on the relationship between perioperative serum albumin (\u0026amp;Albumin) with the occurrence of CI-AKI in patients with coronary heart disease after PCI. The present study was designed to examine the correlation between \u0026amp;Albumin and CI-AKI in patients who underwent PCI.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003ePatients who received their first PCI treatment between January 2017 and January 2019 were selected as potential participants in the Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Inclusion criteria were as follows: adult patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years and patients who agreed to participate in the present study. Exclusion criteria were as follows: (1) Complicated with hypotension or cardiogenic shock; (2) History of allergy to iodine or iodine contrast agent; (3) Chronic renal insufficiency stage 5 or maintenance hemodialysis /peritoneal dialysis patients; (4) CT scan, MRI scan, angiography and other application of contrast agent examination within two weeks before inclusion; imaging examination using other contrast agents is expected to be performed during the study period (except elective PCI 1 week later, the same contrast agent is required); (5) Acute kidney injury or the use of nephrotoxic drugs in the past two weeks; (6) Inflammatory diseases, autoimmune diseases, liver insufficiency, thyroid dysfunction, malignant tumors, infectious diseases; (7) Incomplete collection of patient medical records, especially the lack of renal function evaluation indicators 48 to 72 hours after PCI.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eThe patient's medical history, symptoms, signs, examination, and test results were recorded in detail. Data included age, sex, smoking, hypertension, diabetes, atrial fibrillation, stroke, and body mass index at admission. Left ventricular ejection fraction (LVEF), blood routine examination, biochemistry, basic cardiovascular medication information, and volume of contrast media were recorded. Based on the coronary angiography results, the severity of coronary artery disease was evaluated by the Gensini score\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e, and multivessel disease was defined as \u0026ge;\u0026thinsp;50% diameter stenosis in at least 2 major coronary arteries.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eDiagnostic Criteria of Coronary heart disease (CHD)\u003c/h2\u003e \u003cp\u003eThe diagnostic criteria of CHD depend on the typical angina pectoralis symptoms, ECG changes, and the determination of myocardial injury markers. Coronary angiography is the gold standard for diagnosis, and coronary CTA can also be used for preliminary screening of coronary heart disease. (1) Chest pain symptoms: most of them are crushing pain located in retrosternal and precordial areas, which are related to activity and emotional agitation. According to different types, the duration is different, and the degree of relief of nitrate drugs is different. (2) ECG manifestations: The ECG manifestations of UA and NSTEMI are transient ST segment (elevated or lowered) and T wave (flat or inverted) changes during the onset of chest pain. The ECG of STEMI can show ST-segment elevation, wide and deep Q wave, T wave inversion, and so on. (3) Myocardial injury markers: for patients with STEMI and NSTEMI, myocardial injury markers are elevated at the corresponding time. However, the markers of myocardial injury in UA patients were normal or slightly elevated. (4): Coronary angiography: Coronary angiography is the gold standard for diagnosis. And coronary CTA can also be used for preliminary screening of coronary heart disease.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eClinical Medication and CI-AKI Prevention Strategy\u003c/h2\u003e \u003cp\u003eAll patients received loading doses of double anti-platelet aggregation drugs (aspirin 300mg and clopidogrel 300mg, or ticagrelor 180mg) before surgery, and dual antiplatelet therapy (aspirin 100mg\u0026middot;d\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003eand clopidogrel 75mg\u0026middot;d\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e or ticagrelor 180mg\u0026middot;d\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e) continued for at least 12 months. Use of other medications (\u0026#120573;-receptor blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, nitrate esters, calcium antagonist, and statins) were left to the discretion of individual cardiologists. Adequate hydration remains the main means of CI-AKI prevention, at present the best hydration solution is still inconclusive, sodium chloride solution (NaCl) is widely used hydration solution. Because the study population includes several patients with cardiac insufficiency, it is up to the clinician to decide whether to hydrate according to the situation of the patients. In case of hydration, the following requirements should be followed: 3\u0026ndash;12 hours before surgery and 6\u0026ndash;24 hours after surgery, isotonic crystal solution should be given intravenously at a rate of 1.0ml\u0026middot;kg\u003csup\u003e\u0026minus;1\u003c/sup\u003e\u0026middot;h\u003csup\u003e\u0026minus;1\u003c/sup\u003e-1.5ml\u0026middot;kg\u003csup\u003e\u0026minus;1\u0026middot;\u003c/sup\u003eh\u003csup\u003e\u0026minus;1\u003c/sup\u003e. The use of nephrotoxic drugs during the study (including large-dose loop diuretics, nonsteroidal anti-inflammatory drugs other than aspirin, aminoglycosides, amphotericin B, and traditional Chinese medicine containing aristolochic acid, etc.) should be avoided.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFollow-Up\u003c/h2\u003e \u003cp\u003eThe primary endpoint was the occurrence of major adverse cardiovascular events (MACE), defined as the composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization (PCI or bypass surgery).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis of data was performed using SPSS 27.0 software. Measurement data with a normal distribution were expressed as the mean (x)\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation (s), and a comparison between the two groups was performed by an independent sample t-test. Measurement data with skewed distribution were expressed as M (Q1, Q3), and the Mann-Whitney U test was used for comparison between the two groups. Enumeration data were expressed as a rate or constituent ratio, and comparison between the two groups was performed by the Chi-square test or Fisher's exact probability method. Multivariate logistic regression analysis was employed to analyze the correlation between \u0026amp;Albumin and CI-AKI. The receiver operating characteristic (ROC) curve was used to analyze the optimal cutoff value and area under the curve (AUC) of \u0026amp;Albumin in predicting CI-AKI after PCI. Survival analysis was performed using Kaplan-Meier survival analysis. The log-rank test was used for comparison between the two groups. Multivariate Cox regression was used to analyze the predictors of MACE in CHD patients during 1-year follow-up after PCI. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant using a two-tailed test.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eBaseline Characteristics\u003c/h2\u003e\n \u003cp\u003eA total of 959 patients undergoing PCI were included in this study. The average age was 67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5 years [range:60\u0026ndash;75]. Among these patients, 603 cases (62.9%) were male, 703 cases (73.3%) had hypertension, and 316 cases (33.0%) had diabetes, among which 147 had suffered an attack of CI-AKI. The incidence of CI-AKI in patients with PCI was 15.3% (147/959).\u003c/p\u003e\n \u003cp\u003ePatients were divided into 2 groups based on the optimal cut-off value of \u0026amp;Albumin: high\u0026amp;Alb group (\u0026amp;Alb\u0026thinsp;\u0026ge;\u0026thinsp;4.55 g/L, a total of 440 cases) and a control group (\u0026amp;Alb\u0026thinsp;\u0026lt;\u0026thinsp;4.55 g/L, a total of 519 cases). The incidence of CI-AKI in the high \u0026amp;Albumin group was significantly higher compared to that in the low group [23.6% (104/440) versus 8.3% (43/519), P\u0026lt;0.01]. The comparison of clinical data between the high \u0026amp;Albumin group and the low group is shown in Table\u0026nbsp;\u003cspan\u003e1\u003c/span\u003e. In the high \u0026amp;Albumin group more males, older, had a higher proportion of smoking and had a higher proportion of hypertension (P\u0026lt;0.05).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline characteristics of the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh \u0026amp; Alb group(n\u0026thinsp;=\u0026thinsp;440)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow \u0026amp; Alb group(n\u0026thinsp;=\u0026thinsp;519)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e293 (66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310 (59.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66\u0026thinsp;\u0026plusmn;\u0026thinsp;11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg\u0026middot;m\u003csup\u003e2\u0026thinsp;\u0026minus;\u0026thinsp;1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.89\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystolic BP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135.50\u0026thinsp;\u0026plusmn;\u0026thinsp;18.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137.97\u0026thinsp;\u0026plusmn;\u0026thinsp;21.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiastolic BP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.75\u0026thinsp;\u0026plusmn;\u0026thinsp;12.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.35\u0026thinsp;\u0026plusmn;\u0026thinsp;12.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136 (30.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e113 (21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e308 (70.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e395 (76.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145 (33.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e171 (32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAtrial fibrillation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLVEF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStroke, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123 (23.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedication, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAspirin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e433 (98.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e506 (97.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e240 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e295 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026beta;-blocker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e347 (78.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e403 (77.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStatins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e401 (99.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e381 (99.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAngiography\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGensini score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.7\u0026thinsp;\u0026plusmn;\u0026thinsp;37.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;38.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eContrast dose (mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.6\u0026thinsp;\u0026plusmn;\u0026thinsp;22.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.664\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVessels, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMulti-vessel, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e184 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225 (43.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStents, n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.103\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMulti-stent, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehydration, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e338 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCI-AKI, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104 (23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: Data are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation, mean (25% quartile-75% quartile) or n (%).\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAbbreviations: BMI, body mass index; BP, blood pressure; LVEF, left ventricular ejection fraction; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI-AKI, contrast-induced acute kidney injury; \u0026amp;Albumin, Perioperative Serum Albumin.\u003c/p\u003e\n \u003cp\u003eA comparison of the laboratory parameters between the 2 groups is shown in Table\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e. Patients in the high \u0026amp; Albumin group had a significantly higher baseline platelet count, indirect bilirubin, and uric acid levels than those in the low group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, patients in the high \u0026amp; Albumin group showed a significantly lower level of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and HDL-C compared to patients in the low group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eBaseline laboratory characteristics of the two groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh \u0026amp; Alb group(n\u0026thinsp;=\u0026thinsp;440)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow \u0026amp; Alb group(n\u0026thinsp;=\u0026thinsp;519)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRBC (\u0026times;10\u003csup\u003e12\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWBC (\u0026times;10\u003csup\u003e9\u003c/sup\u003e\u0026middot;\u003csup\u003e/L\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.98\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHGB (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e137.38\u0026thinsp;\u0026plusmn;\u0026thinsp;16.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e135.35\u0026thinsp;\u0026plusmn;\u0026thinsp;17.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePLT (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e213.77\u0026thinsp;\u0026plusmn;\u0026thinsp;67.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e195.8\u0026thinsp;\u0026plusmn;\u0026thinsp;58.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNEU (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.71\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLYM (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.357\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMON (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDBIL (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIBIL (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.29\u0026thinsp;\u0026plusmn;\u0026thinsp;4.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.61\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.15\u0026thinsp;\u0026plusmn;\u0026thinsp;23.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.17\u0026thinsp;\u0026plusmn;\u0026thinsp;20.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.988\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.95\u0026thinsp;\u0026plusmn;\u0026thinsp;25.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.46\u0026thinsp;\u0026plusmn;\u0026thinsp;21.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGlucose (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSCr (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.55\u0026thinsp;\u0026plusmn;\u0026thinsp;34.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81.39\u0026thinsp;\u0026plusmn;\u0026thinsp;23.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUric acid (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e375.01\u0026thinsp;\u0026plusmn;\u0026thinsp;112.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e358.70\u0026thinsp;\u0026plusmn;\u0026thinsp;100.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriglyceride (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTC (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHDL-C (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLDL-C (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.705\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.82\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: Data are the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard deviation, mean (25% quartile-75% quartile) or n (%).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations: RBC, red blood cells; WBC, white blood cells; HGB, hemoglobin; PLT, platelet count; NEU, neutrophil count; LYM, lymphocyte count; MON, monocyte count; DBIL, direct bilirubin; IBIL, indirect bilirubin; ALT, alanine aminotransferase; AST, alanine aminotransferase; SCr, Serum creatinine; TC, Total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; \u0026amp; Albumin, Perioperative Serum Albumin.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003eCorrelations between the \u0026amp;Albumin and CI-AKI\u003c/h2\u003e\n \u003cp\u003eA Pearson correlation analysis showed that the \u0026amp;Albumin was linearly correlated with CI-AKI (r\u0026thinsp;=\u0026thinsp;0.212, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Moreover, ROC curve analysis and AUC values showed (Fig.\u0026nbsp;\u003cspan\u003e2\u003c/span\u003e, Table\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e) that the AUC value of \u0026amp; Albumin for CI-AKI after PCI was 0.675, [95% confidence interval (CI): 0.627\u0026ndash;0.724, P\u0026lt;0.001], the best cut-off value was 4.55 g/L, the sensitivity was70.7%, and the specificity was 58.5%. Postoperative albumin for CI-AKI after PCI was 0.659, [95% confidence interval (CI): 0.626\u0026ndash;0.723, P\u0026lt;0.001], the best cut-off value was 4.55g/L, the sensitivity was70.7%, and the specificity was 58.5%.\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eArea under curve between Variables\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCut-off value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026amp; Alb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.626\u0026ndash;0.723\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative albumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.495\u0026ndash;0.597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative albumin g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.626\u0026ndash;0.723\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eNote: AUC\u0026thinsp;=\u0026thinsp;area under curve; 95%CI\u0026thinsp;=\u0026thinsp;95% confidence interval; CI-AKI, contrast-induced acute kidney injury. \u0026amp; Albumin, Perioperative Serum Albumin.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eTo identify independent predictors of CI-AKI, multivariate logistic regression analysis revealed that a high \u0026amp; Albumin [odds ratio (OR) 2.495, 95% CI: 1.277\u0026ndash;4.874, P\u0026thinsp;=\u0026thinsp;0.007], males (OR 0.616, 95% CI: 0.389\u0026ndash;0.976, P\u0026thinsp;=\u0026thinsp;0.039), a serum creatinine level (OR 1.021, 95% CI: 1.015\u0026ndash;1.027, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and triglyceride level (OR 0.775, 95% CI: 0.627\u0026ndash;0.958, P\u0026thinsp;=\u0026thinsp;0.019), Postoperative albumin level l (OR 0.911, 95% CI: 0.883\u0026ndash;0.940, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hypoproteinemia after surgery (OR 2.497, 95% CI: 1.361\u0026ndash;4.582, P\u0026thinsp;=\u0026thinsp;0.003), and triglyceride level (OR 0.775, 95% CI: 0.627\u0026ndash;0.958, P\u0026thinsp;=\u0026thinsp;0.019) were independent risk factors for the development of CI-AKI.\u003c/p\u003e\n \u003cp\u003eDeLong\u0026apos;s test showed that the diagnostic efficiency of preoperative albumin level was worse than that of postoperative albumin level, with statistical significance (P\u0026lt;0.01). The diagnostic efficiency of preoperative albumin level was lower than that of \u0026amp; Albumin, and the results were statistically significant P\u0026lt;0.01). Diagnostic efficiency of postoperative albumin level was worse than that of \u0026amp; Albumin, and the result was not statistically significant (P\u0026thinsp;=\u0026thinsp;0.417).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\"\u003e\n \u003ch2\u003eAnalysis of \u0026amp; Albumin and long-term clinical outcomes\u003c/h2\u003e\n \u003cp\u003eAll patients completed a 1-year clinical follow-up. Patients with a high \u0026amp; Albumin (\u0026ge;\u0026thinsp;4.55g/L) had worse clinical outcomes, with a greater incidence of primary endpoints [18.6% (82/440) vs14.5% (75/519), P\u0026thinsp;=\u0026thinsp;0.022]. No significant differences were found in all-cause death (1.3% vs 0.1%, P\u0026thinsp;=\u0026thinsp;0.087), and non-fatal myocardial infarction (4.6% vs 3.4%, P\u0026thinsp;=\u0026thinsp;0.342). However, the incidence of target vascular revascularization (16.6% vs 10.2%, P\u0026thinsp;=\u0026thinsp;0.004) was significantly increased in the high \u0026amp; Albumin group. Kaplan-Meier curves are shown in Fig.\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\"\u003e\n \u003ch2\u003e\u003cstrong\u003eEvaluation of the prognostic performance of \u0026amp; Albumin and CI-AKI for MACE\u003c/strong\u003e\u003c/h2\u003e\n \u003cp\u003eTo evaluate the independent predictors of MACE in patients at 1-year follow-up, Cox regression analysis was performed, which showed that CI-AKI was an independent predictor for primary endpoint outcomes at 1-year follow-up [hazard ratio (HR) 1.521, 95% CI:1.036\u0026ndash;2.233, P\u0026thinsp;=\u0026thinsp;0.032]. Another variable showing an independent prognostic impact was multivessel disease (HR3.145, 95% CI:1.839\u0026ndash;5.377, P \u0026lt;0.01). The results of Cox regression analysis are presented in Table\u0026nbsp;\u003cspan\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eContrast agents are commonly used in imaging enhancement, especially in computed tomography and magnetic resonance imaging, or in coronary angiography (CAG) and percutaneous coronary intervention (PCI)\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.In patients undergoing PCI, contrast-induced acute kidney injury (CI-AKI) has become a serious complication that is closely related to clinical adverse events, Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality rates\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Clinical and surgical prognosis of patients with coronary heart disease (CHD) is significantly improved by the use of coronary stenting. However, the incidence of CI-AKI is increasing year by year and has become one of the critical complications in the process of coronary revascularization. Our results showed that CI-AKI increases the occurrence of MACE, and seriously affects the clinical prognosis of patients after PCI. The pathogenesis of CI-AKI is complex, and the definite pathophysiologic basis is still not clear. At present, it is primarily put down to intrarenal vasoconstriction, production of reactive oxygen species and direct tubular injury.After intravascular injection of contrast media, it can induce a variety of factors to lead to renal vasoconstriction, including antidiuretic hormone (ADH), adenosine, endothelin-1 (ET-1), etc\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e,they transiently cause an increase in renal blood arterial flow, followed by persistent severe contraction, eventually causing renal hypoperfusion and renal medullary ischemia and hypoxia\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Oxidative stress injury may also be one of the pathophysiological mechanisms of CI-AKI. The contrast agent can cause a decrease in blood supply in the renal medulla, resulting in the imbalance of metabolic demand and blood supply in the crude ascending branch of the myelin loop of the outer medulla layer, resulting in the production of superoxide, resulting in oxidative necrosis of the renal tubules\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Direct cytotoxicity of contrast agents in vascular endothelial cells results in increased endothelin and adenosine, decreased nitric oxide and prostaglandins \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, and increased fluid viscosity in vascular and tubular cells. Although the majority of contrast media-induced kidney damage can return to normal levels within 1\u0026ndash;4 weeks, multiple risk factors such as CKD and hypotension may lead to loss of functional nephron and impairment of renal function. As the dose of contrast medium increases, the regenerative capacity of tubular epithelial cells is destroyed, and some renal units may eventually become fibrosis and permanently lose function\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e.Contrast agents are allergens that cause systemic allergic reactions and renal immune inflammatory responses and are involved in the mechanisms of CI-AKI\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.Systemic inflammation can cause the kidney to be more susceptible to local inflammation caused by iodinated contrast agents after angiography, thereby further promoting the occurrence of contrast-induced acute kidney injury.\u003c/p\u003e \u003cp\u003eVascular remodeling induced by oxidative stress effect and secondary inflammatory response is the core link of the event chain in coronary artery disease, in which endothelial dysfunction and smooth muscle phenotype conversion imbalance are two key nodes of vascular remodeling. Atherosclerosis is related to many susceptibility factors to CI-AKI and leads to the release of many reactive metabolites that can cause hemodynamic and inflammatory changes that worsen renal blood flow. As one of the routine examination items of hospitalized patients, serum albumin can help the body bind and transport endogenous and exogenous substances, maintain stable colloid osmotic pressure in the blood, remove free radicals harmful to the animal body, and inhibit platelet aggregation to achieve anticoagulant effect\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.In the presence of low serum albumin, oxidatively deformed LDL is cytotoxic and strongly atherogenic\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.In contrast, low expression of albumin increases blood viscosity, which in turn promotes the progression of CHD and even disrupts normal vascular endothelial function, further leading to impaired cardiac function. As indicators of nutritional status and inflammatory factors, perioperative albumin levels and postoperative effects were explored. Several previous studies have shown that perioperative albumin levels are significantly associated with postoperative complications in patients with malignancies including colorectal cancer, gastric cancer, and lung cancer and non-cancer patients\u003csup\u003e[\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.Similarly, the relationship between perioperative albumin and adverse outcomes after abdominal surgery was discussed\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, we found that perioperative albumin decreased (\u0026amp; albumin\u0026thinsp;\u0026ge;\u0026thinsp;4.55 g \u0026middot; L\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e) was an independent risk factor for CI-AKI and an important predictor of MACE 1 year after PCI in patients with coronary heart disease; \u0026amp; albumin\u0026thinsp;\u0026ge;\u0026thinsp;4.55 g \u0026middot; L\u003csup\u003e\u0026minus;\u0026thinsp;1\u003c/sup\u003e could not only be used for the early identification of CI-AKI in the short term after PCI in patients, but also had a high predictive value for MACE 1 year after PCI.\u003c/p\u003e \u003cp\u003eThe incidence of CI-AKI in patients after PCI was found to be as high as 15.3%% in this study, making early identification of patients at risk for CI-AKI extremely important. In terms of CI-AKI, our findings are largely consistent with the results from a clinical study in which890 ACS patients were enrolled who underwent primary PCI, thereby indicating that lower serum albumin levels may predict CI-AKI development after primary PCI in ACS patients\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e .Moreover, the multivariate logistic regression analysis revealed that a high \u0026amp; Albumin [ (OR) 2.495, 95% CI: 1.277\u0026ndash;4.874, P\u0026thinsp;=\u0026thinsp;0.007] can predict CI-AKI development after primary PCI in CHD patients; Receiver operating characteristic curve analysis shows that the \u0026amp; Albumin level is an accurate predictor for the development of CI-AKI; the area under the curve was 0.675 for the baseline \u0026amp; Albumin level (95% CI: 0.627\u0026ndash;0.724, P\u0026lt;0.001). The optimum cutoff point of \u0026amp; Albumin was 4.55 g/L, with a sensitivity of 70.7% and a specificity of 58.5%. These explain that the decrease of perioperative serum albumin can be used as a predictor of CI-AKI after PCI, which helps to identify patients undergoing PCI and high-risk patients with CI-AKI early, thus providing a basis for the development of protective measures. More samples and studies are needed to further prove this point.\u003c/p\u003e \u003cp\u003eBy comparing the baseline data of the two groups of patients, we also found that the patients in the high \u0026amp; albumin group were older and had a lower body mass index, suggesting that the postoperative albumin reduction was more obvious in the older patients, this may be associated with low food intake and poor nutritional status in the elderly. Serum albumin levels are mostly considered to reflect the status of malnutrition and chronic diseases, and the low level of serum albumin will cause a decrease in plasma colloid osmotic pressure, a large amount of fluid retention in the interstitial space, a corresponding reduction in effective circulating blood volume, promote microcirculatory disturbances, lead to hypoperfusion of vital organs, and may produce multiple organ dysfunction. It suggests that we pay more attention to the nutritional status of elderly patients before surgery.\u003c/p\u003e \u003cp\u003eIn addition, at 1-year follow-up, the incidence of MACE was higher in the high \u0026amp; Albumin group than in the low group. Cox regression analysis showed that CI-AKI was an independent predictor of the primary endpoint outcome, suggesting that CI-AKI was associated with an increase in MACE in CHD patients. CI-AKI is strongly associated with an increased adverse prognosis. The results of this study highlight the importance of CI-AKI in MACE \u003csup\u003e[29]\u003c/sup\u003eoccurrences.\u003c/p\u003e \u003cp\u003eThis study has some limitations. Firstly, all cases in the study come from one hospital, so the sample size is small, and there is inevitable selection bias, which needs to be further demonstrated by data with a larger sample size. Furthermore, many factors can affect albumin levels and/or the incidence of myocardial infarction. Although many disease states that may affect the final results are excluded from this study and multi-factor adjustment are performed to reduce bias, there may still be other confounding factors that have not been adjusted for enrollment that has affected the results.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSerum albumin levels measured pre and post albumin concentration is helpful to identify CI-AKI after PCI and predict long-term prognosis. According to the level of perioperative albumin reduction, clinicians can be encouraged to carry out additional CI-AKI prevention and close follow-up of high-risk patients, to ultimately improve the prognosis of patients, which have certain clinical significance and application value.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the open research fund of Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments，Southeast University (No. KF202304). We are grateful to the staff in the Biobank of Zhongda Hospital Affiliated with Southeast University for technical assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with approval from the Ethics Committee of Zhongda Hospital, Southeast University Medical School. This study was conducted following the Declaration of Helsinki. Written informed consent was obtained from all participants.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests concerning this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData related to this manuscript can be made available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKooiman J, van de Peppel W R, Sijpkens Y W, et al. No increase in Kidney Injury Molecule-1 and Neutrophil Gelatinase-Associated Lipocalin excretion following intravenous contrast enhanced-CT[J]. Eur Radiol, 2015,25(7):1926-1934.\u003c/li\u003e\n\u003cli\u003eAli Z A, Karimi G K, Nazif T, et al. Imaging- and physiology-guided percutaneous coronary intervention without contrast administration in advanced renal failure: a feasibility, safety, and outcome study[J]. Eur Heart J, 2016,37(40):3090-3095.\u003c/li\u003e\n\u003cli\u003eRudnick M R, Leonberg-Yoo A K, Litt H I, et al. The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?[J]. Am J Kidney Dis, 2020,75(1):105-113.\u003c/li\u003e\n\u003cli\u003evan der Molen A J, Reimer P, Dekkers I A, et al. Post-contrast acute kidney injury - Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines[J]. Eur Radiol, 2018,28(7):2845-2855.\u003c/li\u003e\n\u003cli\u003eAndreis A, Budano C, Levis M, et al. Contrast-induced kidney injury: how does it affect long-term cardiac mortality?[J]. J Cardiovasc Med (Hagerstown), 2017,18(11):908-915.\u003c/li\u003e\n\u003cli\u003eLevitt D G, Levitt M D. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements[J]. Int J Gen Med, 2016,9:229-255.\u003c/li\u003e\n\u003cli\u003eDjousse L, Rothman K J, Cupples L A. Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham Offspring Study[J]. Circulation, 2002,106(23):2919-2924.\u003c/li\u003e\n\u003cli\u003eWang M, Liu J, Ma C, et al. Synergistic association of serum albumin and globulin with coronary heart disease[J]. J Atheroscler Thromb, 2012,19(7):619-632.\u003c/li\u003e\n\u003cli\u003eGillum RF I D M D. Relation between serum albumin concentration and stroke incidence and death: the NHANES I Epidemiologic Follow-up Study.[J]. Am J Epidemiol, 1994.\u003c/li\u003e\n\u003cli\u003eMurat S N, Kurtul A, Yarlioglues M. Impact of Serum Albumin Levels on Contrast-Induced Acute Kidney Injury in Patients With Acute Coronary Syndromes Treated With Percutaneous Coronary Intervention[J]. Angiology, 2015,66(8):732-737.\u003c/li\u003e\n\u003cli\u003eHardt J, Pilz L, Magdeburg J, et al. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection[J]. Int J Colorectal Dis, 2017,32(10):1439-1446.\u003c/li\u003e\n\u003cli\u003eUppal S, Al-Niaimi A, Rice L W, et al. Preoperative hypoalbuminemia is an independent predictor of poor perioperative outcomes in women undergoing open surgery for gynecologic malignancies[J]. Gynecol Oncol, 2013,131(2):416-422.\u003c/li\u003e\n\u003cli\u003eLi P, Li J, Lai Y, et al. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study[J]. J Thorac Dis, 2018,10(10):5755-5763.\u003c/li\u003e\n\u003cli\u003eBohl D D, Shen M R, Hannon C P, et al. Serum Albumin Predicts Survival and Postoperative Course Following Surgery for Geriatric Hip Fracture[J]. J Bone Joint Surg Am, 2017,99(24):2110-2118.\u003c/li\u003e\n\u003cli\u003eLabgaa I, Joliat G R, Kefleyesus A, et al. Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre[J]. BMJ Open, 2017,7(4):e13966.\u003c/li\u003e\n\u003cli\u003eIssangya C E, Msuya D, Chilonga K, et al. Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania[J]. BMC Surg, 2020,20(1):155.\u003c/li\u003e\n\u003cli\u003eGensini G G. A more meaningful scoring system for determining the severity of coronary heart disease[J]. Am J Cardiol, 1983,51(3):606.\u003c/li\u003e\n\u003cli\u003eLee S E, Jang J E, Kim H S, et al. Mesenchymal stem cells prevent the progression of diabetic nephropathy by improving mitochondrial function in tubular epithelial cells[J]. Experimental \u0026amp; Molecular Medicine, 2019,51(7):1-14.\u003c/li\u003e\n\u003cli\u003eChang C F, Lin C C. Current concepts of contrast-induced nephropathy: a brief review[J]. J Chin Med Assoc, 2013,76(12):673-681.\u003c/li\u003e\n\u003cli\u003eHossain M A, Costanzo E, Cosentino J, et al. Contrast-induced nephropathy: Pathophysiology, risk factors, and prevention[J]. Saudi J Kidney Dis Transpl, 2018,29(1):1-9.\u003c/li\u003e\n\u003cli\u003eLiu L Y, Liu Y, Wu M Y, et al. Efficacy of atorvastatin on the prevention of contrast-induced acute kidney injury: a meta-analysis[J]. Drug Des Devel Ther, 2018,12:437-444.\u003c/li\u003e\n\u003cli\u003eDugbartey G J, Redington A N. Prevention of contrast-induced nephropathy by limb ischemic preconditioning: underlying mechanisms and clinical effects[J]. Am J Physiol Renal Physiol, 2018,314(3):F319-F328.\u003c/li\u003e\n\u003cli\u003ePisani A, Riccio E, Andreucci M, et al. Role of reactive oxygen species in pathogenesis of radiocontrast-induced nephropathy[J]. Biomed Res Int, 2013,2013:868321.\u003c/li\u003e\n\u003cli\u003eSun G, Chen J Y, Liu Y. Contrast-Induced Nephropathy: Further Investigations About Risk Factors Are Required[J]. Angiology, 2019,70(8):784-785.\u003c/li\u003e\n\u003cli\u003eAbizaid A S, Clark C E, Mintz G S, et al. Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency[J]. Am J Cardiol, 1999,83(2):260-263, A5.\u003c/li\u003e\n\u003cli\u003eYingxia Zhang Y Z. Function and application of serum albumin[J]. Journal of Hainan University (Natural Science Edition), 2007(03):315-320.\u003c/li\u003e\n\u003cli\u003eTsirpanlis G, Bagos P, Ioannou D, et al. Exploring inflammation in hemodialysis patients: persistent and superimposed inflammation. A longitudinal study[J]. Kidney Blood Press Res, 2004,27(2):63-70.\u003c/li\u003e\n\u003cli\u003eLiu T, Lee S R. Poor Prognosis of Contrast-Induced Nephropathy during Long Term Follow Up[J]. Chonnam Med J, 2021,57(3):197-203.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Contrast-induced acute kidney injury, Perioperative Serum Albumin(\u0026Albumin), Percutaneous coronary intervention","lastPublishedDoi":"10.21203/rs.3.rs-3906192/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3906192/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eContrast-induced acute kidney injury (CI-AKI) is a common complication in patients undergoing percutaneous coronary intervention (PCI). Studies have shown that perioperative serum albumin levels may play a role in the occurrence of CI-AKI. This study aimed to investigate the effect of perioperative serum albumin (delta Albumin or \u0026amp;Alb) on the occurrence and long-term prognosis of CI-AKI after PCI.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 959 patients who underwent PCI between January 2017 and January 2019 were selected for the study. Receiver operating characteristic curve was used to determine the optimal cut-off value of \u0026amp;Alb in predicting CI-AKI after PCI. Patients were divided into two groups based on the optimal cut-off value: the high \u0026amp;Alb group (\u0026amp;Alb\u0026thinsp;\u0026ge;\u0026thinsp;4.55 g/L) and the control group (\u0026amp;Alb\u0026thinsp;\u0026lt;\u0026thinsp;4.55 g/L). The incidence of CI-AKI and major adverse cardiac events (MACE, including all-cause death, nonfatal myocardial infarction, and target vessel revascularization) was compared between the groups. Cox regression analysis was used to identify predictors of long-term prognosis after PCI.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 959 patients, 147(15.3%) developed CI-AKI after PCI. The CI-AKI group had a higher level of delta Albumin than the non-CI-AKI group ([6.14 (3.90\u0026ndash;9.10) versus 3.48 (4.31\u0026ndash;6.57), P\u0026thinsp;\u0026lt;\u0026thinsp;0.01)]. The incidence of CI-AKI in the high \u0026amp; Alb group was significantly higher compared to the low group (23.6% versus 8.3%, P\u0026lt;0.01). After a 1-year follow-up, the incidence of MACE was significantly higher in the high delta Albumin group than in the low group (18.6% versus 14.5%, P\u0026thinsp;=\u0026thinsp;0.030). Cox regression analysis confirmed that CI-AKI was an independent predictor of MACE at the 1-year follow-up (HR 1.43, 95% CI 1.04\u0026ndash;1.96, P\u0026thinsp;=\u0026thinsp;0.028). In addition, patients with low preoperative serum albumin had a significantly higher incidence of MACE than those with high preoperative serum albumin (23.2% versus 19.5%, P\u0026thinsp;=\u0026thinsp;0.013).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn summary, baseline high delta Albumin levels are an independent risk factor for CI-AKI in patients after PCI. Furthermore, the occurrence of CI-AKI in the perioperative period is also an independent predictor of long-term prognosis after PCI. These findings highlight the importance of monitoring delta Albumin levels and taking steps to prevent CI-AKI in patients undergoing PCI.\u003c/p\u003e","manuscriptTitle":"The Relationship between Perioperative Serum Albumin and Contrast-induced Acute Kidney Injury in Patients after Percutaneous Coronary intervention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-06 17:26:31","doi":"10.21203/rs.3.rs-3906192/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-16T17:45:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-04T09:27:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"003bf789-2f58-4eeb-90e8-e175153d9c7e_SNPRID","date":"2024-02-03T15:49:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-03T15:34:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-03T15:29:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-03T14:56:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-03T14:54:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-01-28T15:19:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a4ec757-5c57-4a67-b5af-acec6e1e0ef4","owner":[],"postedDate":"February 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-13T07:57:24+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-06 17:26:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3906192","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3906192","identity":"rs-3906192","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}