Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia

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Abstract

BACKGROUND: In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.

METHODS AND RESULTS: At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)-46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA-C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA-C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55-0.69]; P=0.001) and ΔA-C (area under the curve: 0.62 [95% confidence interval, 0.54-0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA-C to acute glycemia allowed proper AKI risk prediction in 16% of patients.

CONCLUSIONS: In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

Original languageEnglish
JournalJournal of the American Heart Association
Volume7
Issue number8
DOIs
Publication statusPublished - Apr 13 2018

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Acute Kidney Injury
Myocardial Infarction
Area Under Curve
Confidence Intervals
Glycosylated Hemoglobin A
ROC Curve
Hyperglycemia
Diabetes Mellitus
Glucose
Incidence

Cite this

@article{8698869d36f34c9e9bf0bd17c9ffea73,
title = "Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role of Acute and Chronic Glycemia",
abstract = "BACKGROUND: In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.METHODS AND RESULTS: At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c ({\%})-46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA-C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16{\%}) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12{\%}, 14{\%}, 22{\%}; P=0.02 for trend) and ΔA-C (13{\%}, 13{\%}, 23{\%}; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95{\%} confidence interval, 0.55-0.69]; P=0.001) and ΔA-C (area under the curve: 0.62 [95{\%} confidence interval, 0.54-0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA-C to acute glycemia allowed proper AKI risk prediction in 16{\%} of patients.CONCLUSIONS: In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.",
author = "Giancarlo Marenzi and Nicola Cosentino and Valentina Milazzo and {De Metrio}, Monica and Mara Rubino and Jeness Campodonico and Marco Moltrasio and Ivana Marana and Marco Grazi and Gianfranco Lauri and Alice Bonomi and Simone Barbieri and Emilio Assanelli and {Dalla Cia}, Alessia and Roberto Manfrini and Roberto Ceriani and Antonio Bartorelli",
note = "{\circledC} 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",
year = "2018",
month = "4",
day = "13",
doi = "10.1161/JAHA.117.008122",
language = "English",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction

T2 - Role of Acute and Chronic Glycemia

AU - Marenzi, Giancarlo

AU - Cosentino, Nicola

AU - Milazzo, Valentina

AU - De Metrio, Monica

AU - Rubino, Mara

AU - Campodonico, Jeness

AU - Moltrasio, Marco

AU - Marana, Ivana

AU - Grazi, Marco

AU - Lauri, Gianfranco

AU - Bonomi, Alice

AU - Barbieri, Simone

AU - Assanelli, Emilio

AU - Dalla Cia, Alessia

AU - Manfrini, Roberto

AU - Ceriani, Roberto

AU - Bartorelli, Antonio

N1 - © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

PY - 2018/4/13

Y1 - 2018/4/13

N2 - BACKGROUND: In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.METHODS AND RESULTS: At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)-46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA-C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA-C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55-0.69]; P=0.001) and ΔA-C (area under the curve: 0.62 [95% confidence interval, 0.54-0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA-C to acute glycemia allowed proper AKI risk prediction in 16% of patients.CONCLUSIONS: In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

AB - BACKGROUND: In acute myocardial infarction, acute hyperglycemia is a predictor of acute kidney injury (AKI), particularly in patients without diabetes mellitus. This emphasizes the importance of an acute glycemic rise rather than glycemia level at admission. We investigated whether, in diabetic patients with acute myocardial infarction, the combined evaluation of acute and chronic glycemic levels may have better prognostic value for AKI than admission glycemia.METHODS AND RESULTS: At admission, we prospectively measured glycemia and estimated average chronic glucose levels (mg/dL) using glycosylated hemoglobin (HbA1c), according to the following formula: 28.7×HbA1c (%)-46.7. We evaluated the association with AKI of the acute/chronic glycemic ratio and of the difference between acute and chronic glycemia (ΔA-C). We enrolled 474 diabetic patients with acute myocardial infarction. Of them, 77 (16%) experienced AKI. The incidence of AKI increased in parallel with the acute/chronic glycemic ratio (12%, 14%, 22%; P=0.02 for trend) and ΔA-C (13%, 13%, 23%; P=0.01) but not with admission glycemic tertiles (P=0.22). At receiver operating characteristic analysis, the acute/chronic glycemic ratio (area under the curve: 0.62 [95% confidence interval, 0.55-0.69]; P=0.001) and ΔA-C (area under the curve: 0.62 [95% confidence interval, 0.54-0.69]; P=0.002) accurately predicted AKI, without difference in the area under the curve between them (P=0.53). At reclassification analysis, the addition of the acute/chronic glycemic ratio and ΔA-C to acute glycemia allowed proper AKI risk prediction in 16% of patients.CONCLUSIONS: In diabetic patients with acute myocardial infarction, AKI is better predicted by the combined evaluation of acute and chronic glycemic values than by assessment of admission glycemia alone.

U2 - 10.1161/JAHA.117.008122

DO - 10.1161/JAHA.117.008122

M3 - Article

C2 - 29654205

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 8

ER -