Effect of hs-CRP levels on renal function impairment in patients with acute coronary syndrome after PCI and the effect of atorvastatin

ZHU Xiao-gang; WANG Li-yue; REN Hao-jin; LIU Jin-hua

doi:10.3969/j.issn.1674-4055.2016.10.23

Abstract：Objective To investigate the effect of high-sensitivity C-reactive protein (hs-CRP) on contrast induced acute kidney injury(CI-AKI) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and the effect of atorvastatin intervention.Methods According to the level of preoperative hs-CRP, 272 ACS patients were divided into three groups: significant high hs-CRP group (hs-CRP≥3 mg/L,n=177), high hs-CRP group (hs-CRP1-3 mg/L,n=62) and normal hs-CRP group (hs-CR<1mg/L,n=33). According to the dosage of preoperative atorvastatin, the significant high hs-CRP group was further divided into 10 mg group (n=52), 20 mg group (n=65) and 40 mg group (n=60). Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (Cys C), hs-CRP were measured before and at 1 day and 2 days after PCI. Creatinine clearance rate (CCr) and glomerular filtration rate (GFR) were calculated according to Scr and Cys C. Risk factors for CI-AKl were determined by multivariate Logistic regression analysis. Results The levels of Cys C and Scr were higher and the GFR level was lower in significant high hs-CRP group than that in normal hs-CRP group after PCI (P<0.05). The level of Cys C was higher and the GFR level was lower in high hs-CRP group than that in normal hs-CRP group after PCI (P<0.05), but there was no significant difference for Scr (P>0.05). CI-AKI occurred in 104 patients (38.2%), 78 (44.07%) in significant high hs-CRP group, 22 (35.48%) in high hs-CRP group and 7 (21.1%) in normal hs-CRP group. The difference of CI-AKI occurrence rate was statistically significant (P<0.05). The GFR level was higher in 40 mg group than that in 20 mg group and 10 mg group after PCI (P<0.05). The levels of Cys C and hs-CRP were lower in 40 mg group and 20 mg group than that in 10 mg group (P<0.05).Results of logistic regression analysis showed that high dose of atorvastatin was the protective factor of postoperative CI-AKI. Preoperative high levels of hs-CRP, diabetes mellitus, renal insufficiency and high age were independent risk factors of CI-AKI (P<0.05).Conclusion High levels of hs-CRP were independent risk factors for CI-AKI in patients with ACS undergoing PCI. The high dose of atorvastatin before PCI can significantly reduce the hs-CRP level, and reduce the contrast agent on renal function damage.