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Acute Kidney Injury in Diabetic Patients With Acute Myocardial Infarction: Role
of Acute and Chronic Glycemia
#MMPMID29654205
Marenzi G
; Cosentino N
; Milazzo V
; De Metrio M
; Rubino M
; Campodonico J
; Moltrasio M
; Marana I
; Grazi M
; Lauri G
; Bonomi A
; Barbieri S
; Assanelli E
; Dalla Cia A
; Manfrini R
; Ceriani R
; Bartorelli A
J Am Heart Assoc
2018[Apr]; 7
(8
): ? PMID29654205
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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 (HbA(1c)),
according to the following formula: 28.7×HbA(1c) (%)-46.7. We evaluated the
association with AKI of the acute/chronic glycemic ratio and of the difference
between acute and chronic glycemia (?(A-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 ?(A-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 ?(A-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 ?(A-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.
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