Naples prognostic score predicts acute kidney injury in acute coronary syndrome patients undergoing primary percutaneous coronary intervention
Abstract
Aims: Acute kidney injury (AKI) is a frequent complication in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). The Naples prognostic score (NPS), which integrates inflammatory and nutritional markers, may improve identification of patients at higher risk for AKI. This study aimed to evaluate the predictive value of NPS for AKI in ACS patients undergoing PCI.
Methods: We retrospectively analyzed 1360 ACS patients treated with PCI. AKI was defined as an increase in serum creatinine ≥0.5 mg/dl or ≥25% from baseline within 48–72 hours after the procedure. NPS was calculated using serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Patients were categorized into low-risk (NPS 0–2) and high-risk (NPS 3–4) groups. Logistic regression and ROC analysis were performed.
Results: AKI occurred in 221 patients (16.3%). Patients with AKI were older and had higher rates of diabetes, heart failure (HF), and LAD involvement. In multivariate analysis, high NPS was independently associated with AKI (OR=4.127, 95% CI: 4.008–4.460, p<0.001), along with diabetes and HF. NPS showed good predictive ability (AUC=0.823), outperforming albumin, cholesterol, NLR, and LMR individually.
Conclusion: NPS is a simple and effective tool to predict AKI in ACS patients undergoing PCI. It may aid in early risk stratification and guide preventive strategies in clinical practice.
Keywords
Acute coronary syndrome acute kidney injury Naples prognostic score percutaneous coronary intervention inflammation
References
- Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res. 2014; 114(12):1959-1975. doi:10.1161/CIRCRESAHA.114.302782
- Masoomi Z, Nasirian AM, Namazi M, et al. Prevalence of contrast-induced nephropathy after primary percutaneous coronary intervention at a tertiary referral hospital. Heliyon. 2024;10(4):e25926. doi:10.1016/j.heliyon.2024.e25926
- Khalfallah M, Allaithy A, Maria DA. Incidence, predictors and outcomes of contrast induced nephropathy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Glob Heart. 2021;16(1):57. doi:10.5334/gh.1071
- Pickering JW, Blunt IR, Than MP. Acute kidney injury and mortality prognosis in acute coronary syndrome patients: a meta-analysis. Nephrology. 2018;23(3):237-246. doi:10.1111/nep.12984
- Yang Y, George KC, Luo R, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol. 2018;19(1):374. doi:10.1186/s12882-018-1161-5
- Brown JR, Rezaee ME, Nichols EL, Marshall EJ, Siew ED, Matheny ME. Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the national inpatient sample. J Am Heart Assoc. 2016;5(3):e002739. doi:10. 1161/JAHA.115.002739
- Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35(7):455-469. doi:10.1093/eurheartj/eht386
- Zhang Y-f, Liu D-d, Zhou Y, Lou J-z. Acute kidney injury in patients with acute coronary syndrome after percutaneous coronary intervention: pathophysiologies, risk factors, and preventive measures. Cardiology. 2021;146(6):678-689. doi:10.1159/000517991
- Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;(100):S11-S15. doi:10.1038/sj.ki.5000368
- Shacham Y, Gal-Oz A, Leshem-Rubinow E, et al. Association of admission hemoglobin levels and acute kidney injury among myocardial infarction patients treated with primary percutaneous intervention. Can J Cardiol. 2015;31(1):50-55. doi:10.1016/j.cjca.2014.11.001
- Nikolsky E, Mehran R, Turcot D, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol. 2004;94(3):300-305. doi:10.1016/j.amjcard.2004.04.023
- Barrett BJ, Parfrey PS. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006;354(4):379-386. doi:10.1056/NEJMcp 050801
- Abellás-Sequeiros R, Raposeiras-Roubín S, Abu-Assi E, et al. Mehran contrast nephropathy risk score: is it still useful 10 years later? J Cardiol. 2016;67(3):262-267. doi:10.1016/j.jjcc.2015.05.007
- Tsai TT, Patel UD, Chang TI, et al. Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J Am Heart Assoc. 2014;3(6):e001380. doi:10.1161/JAHA.114.001380
- Galizia G, Lieto E, Auricchio A, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum. 2017;60(12):1273-1284. doi:10.1097/DCR. 0000000000000961
- Kılıç O, Suygun H, Mustu M, et al. Is the Naples prognostic score useful for predicting heart failure mortality. Kardiologiia. 2023;63(3):61-65. doi:10.18087/cardio.2023.3.n2328
- Saygi M, Tanalp AC, Tezen O, et al. The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction. Coronary Artery Dis. 2024; 35(1):31-37. doi:10.1097/MCA.0000000000001285
- Karakoyun S, Cagdas M, Celik AI, et al. Predictive value of the Naples prognostic score for acute kidney injury in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Angiology. 2024;75(6):576-584. doi:10.1177/ 00033197231161922
- Bağcı A, Aksoy F, Baş HA. Systemic immune-inflammation index may predict the development of contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction. Angiology. 2022;73(3): 218-224. doi:10.1177/00033197211030053
- Yildiz C, Yuksel Y, Efe SC, et al. Value of systemic inflammation-response index in predicting contrast-induced nephropathy in patients with ST-elevation myocardial infarction. Acta Cardiol. 2023;78(8):930-936. doi:10.1080/00015385.2023.2218020
- Murat SN, 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. Angiology. 2015;66(8):732-737. doi:10.1177/0003319714551979
- Liu Y, Tan N, Zhou Y-L, et al. High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol. 2012;25(3):332-340. doi:10.5301/jn. 5000007
- Kaya A, Kaya Y, Topçu S, et al. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65(1):51-56. doi: 10.1177/0003319713484789
- Karauzum I, Karauzum K, Acar B, et al. Predictive value of lymphocyte-to-monocyte ratio in patients with contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome. J Transl Int Med. 2021;9(2):123-130. doi:10.2478/jtim-2021-0024
- Özen Y, Kanal HEŞ, Özbay MB, et al. A new inflammatory marker of the no-reflow phenomenon after percutaneous coronary intervention (PCI) to saphenous venous in patients with coronary artery disease. Iranian Red Crescent Med J. 2023;25(11):e2293.
- Özen Y, Özbay MB. Assessment of systemic immune-inflammation index as an independent surrogate biomarker of no-reflow phenomenon in acute coronary syndrome patients with coronary artery bypass grafting undergoing percutaneous coronary intervention of saphenous vein graft. Eur Rev Med Pharmacol Sci. 2023;27(6):2394-2403. doi:10. 26355/eurrev_202303_31774
- Özen Y, Erdöl A, Özbay MB, Erdoğan M. The prognostic role of the systemic inflammatory index (SII) in heart failure patients: systemic inflammatory index and heart failure. IJCMBS. 2023;3(1):45-50. doi:10. 5281/zenodo.7657891
- Kurtul A, Gok M, Esenboga K. Prognostic nutritional index predicts contrast-associated acute kidney injury in patients with ST-segment elevation myocardial infarction. Acta Cardiol Sin. 2021;37(5):496-503. doi:10.6515/ACS.202109_37(5).20210413A
- Don BR, Kaysen G. Poor nutritional status and inflammation: serum albumin: relationship to inflammation and nutrition. Seminars in dialysis; 2004: Wiley Online Library.
- Roche M, Rondeau P, Singh NR, Tarnus E, Bourdon E. The antioxidant properties of serum albumin. FEBS Lett. 2008;582(13):1783-1787. doi:10. 1016/j.febslet.2008.04.057
- Wiedermann CJ. Anti-inflammatory activity of albumin. Crit Care Med. 2007;35(3):981-983. doi:10.1097/01.ccm.0000257234.87784.91
Naples prognostik skoru, primer perkütan koroner girişim uygulanan akut koroner sendrom hastalarında akut böbrek hasarını öngörür
Abstract
Amaç: Akut böbrek hasarı (ABH), akut koroner sendrom (AKS) nedeniyle perkütan koroner girişim (PKG) uygulanan hastalarda sık görülen bir komplikasyondur. Enflamatuar ve beslenme ile ilişkili belirteçleri birleştiren Naples Prognostic Score (NPS), ABH riski yüksek hastaların belirlenmesine yardımcı olabilir. Bu çalışma, PKG uygulanan AKS hastalarında NPS’nin ABH öngörüsündeki değerini değerlendirmeyi amaçladı.
Yöntem: PKG ile tedavi edilen 1360 AKS hastasını retrospektif olarak analiz ettik. ABH, işlemden sonraki 48–72 saat içinde serum kreatinin düzeyinde ≥0.5 mg/dL ya da ≥%25 artış olarak tanımlandı. NPS; serum albümin, total kolesterol, nötrofil/lenfosit oranı (NLR) ve lenfosit/monosit oranı (LMR) kullanılarak hesaplandı. Hastalar, NPS’ye göre düşük risk (0–2) ve yüksek risk (3–4) gruplarına ayrıldı. Lojistik regresyon ve ROC analizleri uygulandı.
Bulgular: ABH, 221 hastada (%16,3) gelişti. ABH gelişen hastalar daha yaşlıydı ve diyabet, kalp yetersizliği ve LAD tutulum oranları daha yüksekti. Çok değişkenli analizde, yüksek NPS, diyabet ve kalp yetersizliği ile birlikte ABH ile bağımsız olarak ilişkiliydi (OR = 4.127, %95 GA: 4.008–4.460, p < 0.001). NPS, ABH için iyi bir öngörücü performans gösterdi (EAA = 0.823) ve albümin, kolesterol, NLR ve LMR gibi bireysel bileşenlerinden daha üstün bulundu.
Sonuç: NPS, PKG uygulanan AKS hastalarında ABH’yi öngörmede basit ve etkili bir araçtır. Klinik uygulamada erken risk sınıflandırmasına katkı sağlayabilir ve önleyici stratejilere yön verebilir.
Keywords
akut koroner sendrom akut böbrek hasarı Naples prognostik skoru perkütan koroner girişim inflamasyon
References
- Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res. 2014; 114(12):1959-1975. doi:10.1161/CIRCRESAHA.114.302782
- Masoomi Z, Nasirian AM, Namazi M, et al. Prevalence of contrast-induced nephropathy after primary percutaneous coronary intervention at a tertiary referral hospital. Heliyon. 2024;10(4):e25926. doi:10.1016/j.heliyon.2024.e25926
- Khalfallah M, Allaithy A, Maria DA. Incidence, predictors and outcomes of contrast induced nephropathy in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Glob Heart. 2021;16(1):57. doi:10.5334/gh.1071
- Pickering JW, Blunt IR, Than MP. Acute kidney injury and mortality prognosis in acute coronary syndrome patients: a meta-analysis. Nephrology. 2018;23(3):237-246. doi:10.1111/nep.12984
- Yang Y, George KC, Luo R, et al. Contrast-induced acute kidney injury and adverse clinical outcomes risk in acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis. BMC Nephrol. 2018;19(1):374. doi:10.1186/s12882-018-1161-5
- Brown JR, Rezaee ME, Nichols EL, Marshall EJ, Siew ED, Matheny ME. Incidence and in-hospital mortality of acute kidney injury (AKI) and dialysis-requiring AKI (AKI-D) after cardiac catheterization in the national inpatient sample. J Am Heart Assoc. 2016;5(3):e002739. doi:10. 1161/JAHA.115.002739
- Damman K, Valente MA, Voors AA, O'Connor CM, van Veldhuisen DJ, Hillege HL. Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis. Eur Heart J. 2014;35(7):455-469. doi:10.1093/eurheartj/eht386
- Zhang Y-f, Liu D-d, Zhou Y, Lou J-z. Acute kidney injury in patients with acute coronary syndrome after percutaneous coronary intervention: pathophysiologies, risk factors, and preventive measures. Cardiology. 2021;146(6):678-689. doi:10.1159/000517991
- Mehran R, Nikolsky E. Contrast-induced nephropathy: definition, epidemiology, and patients at risk. Kidney Int Suppl. 2006;(100):S11-S15. doi:10.1038/sj.ki.5000368
- Shacham Y, Gal-Oz A, Leshem-Rubinow E, et al. Association of admission hemoglobin levels and acute kidney injury among myocardial infarction patients treated with primary percutaneous intervention. Can J Cardiol. 2015;31(1):50-55. doi:10.1016/j.cjca.2014.11.001
- Nikolsky E, Mehran R, Turcot D, et al. Impact of chronic kidney disease on prognosis of patients with diabetes mellitus treated with percutaneous coronary intervention. Am J Cardiol. 2004;94(3):300-305. doi:10.1016/j.amjcard.2004.04.023
- Barrett BJ, Parfrey PS. Preventing nephropathy induced by contrast medium. N Engl J Med. 2006;354(4):379-386. doi:10.1056/NEJMcp 050801
- Abellás-Sequeiros R, Raposeiras-Roubín S, Abu-Assi E, et al. Mehran contrast nephropathy risk score: is it still useful 10 years later? J Cardiol. 2016;67(3):262-267. doi:10.1016/j.jjcc.2015.05.007
- Tsai TT, Patel UD, Chang TI, et al. Validated contemporary risk model of acute kidney injury in patients undergoing percutaneous coronary interventions: insights from the National Cardiovascular Data Registry Cath-PCI Registry. J Am Heart Assoc. 2014;3(6):e001380. doi:10.1161/JAHA.114.001380
- Galizia G, Lieto E, Auricchio A, et al. Naples prognostic score, based on nutritional and inflammatory status, is an independent predictor of long-term outcome in patients undergoing surgery for colorectal cancer. Dis Colon Rectum. 2017;60(12):1273-1284. doi:10.1097/DCR. 0000000000000961
- Kılıç O, Suygun H, Mustu M, et al. Is the Naples prognostic score useful for predicting heart failure mortality. Kardiologiia. 2023;63(3):61-65. doi:10.18087/cardio.2023.3.n2328
- Saygi M, Tanalp AC, Tezen O, et al. The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction. Coronary Artery Dis. 2024; 35(1):31-37. doi:10.1097/MCA.0000000000001285
- Karakoyun S, Cagdas M, Celik AI, et al. Predictive value of the Naples prognostic score for acute kidney injury in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Angiology. 2024;75(6):576-584. doi:10.1177/ 00033197231161922
- Bağcı A, Aksoy F, Baş HA. Systemic immune-inflammation index may predict the development of contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction. Angiology. 2022;73(3): 218-224. doi:10.1177/00033197211030053
- Yildiz C, Yuksel Y, Efe SC, et al. Value of systemic inflammation-response index in predicting contrast-induced nephropathy in patients with ST-elevation myocardial infarction. Acta Cardiol. 2023;78(8):930-936. doi:10.1080/00015385.2023.2218020
- Murat SN, 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. Angiology. 2015;66(8):732-737. doi:10.1177/0003319714551979
- Liu Y, Tan N, Zhou Y-L, et al. High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol. 2012;25(3):332-340. doi:10.5301/jn. 5000007
- Kaya A, Kaya Y, Topçu S, et al. Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention. Angiology. 2014;65(1):51-56. doi: 10.1177/0003319713484789
- Karauzum I, Karauzum K, Acar B, et al. Predictive value of lymphocyte-to-monocyte ratio in patients with contrast-induced nephropathy after percutaneous coronary intervention for acute coronary syndrome. J Transl Int Med. 2021;9(2):123-130. doi:10.2478/jtim-2021-0024
- Özen Y, Kanal HEŞ, Özbay MB, et al. A new inflammatory marker of the no-reflow phenomenon after percutaneous coronary intervention (PCI) to saphenous venous in patients with coronary artery disease. Iranian Red Crescent Med J. 2023;25(11):e2293.
- Özen Y, Özbay MB. Assessment of systemic immune-inflammation index as an independent surrogate biomarker of no-reflow phenomenon in acute coronary syndrome patients with coronary artery bypass grafting undergoing percutaneous coronary intervention of saphenous vein graft. Eur Rev Med Pharmacol Sci. 2023;27(6):2394-2403. doi:10. 26355/eurrev_202303_31774
- Özen Y, Erdöl A, Özbay MB, Erdoğan M. The prognostic role of the systemic inflammatory index (SII) in heart failure patients: systemic inflammatory index and heart failure. IJCMBS. 2023;3(1):45-50. doi:10. 5281/zenodo.7657891
- Kurtul A, Gok M, Esenboga K. Prognostic nutritional index predicts contrast-associated acute kidney injury in patients with ST-segment elevation myocardial infarction. Acta Cardiol Sin. 2021;37(5):496-503. doi:10.6515/ACS.202109_37(5).20210413A
- Don BR, Kaysen G. Poor nutritional status and inflammation: serum albumin: relationship to inflammation and nutrition. Seminars in dialysis; 2004: Wiley Online Library.
- Roche M, Rondeau P, Singh NR, Tarnus E, Bourdon E. The antioxidant properties of serum albumin. FEBS Lett. 2008;582(13):1783-1787. doi:10. 1016/j.febslet.2008.04.057
- Wiedermann CJ. Anti-inflammatory activity of albumin. Crit Care Med. 2007;35(3):981-983. doi:10.1097/01.ccm.0000257234.87784.91
Details
| Primary Language | English |
|---|---|
| Subjects | Cardiology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | July 28, 2025 |
| Submission Date | June 30, 2025 |
| Acceptance Date | July 20, 2025 |
| Published in Issue | Year 2025 Volume: 7 Issue: 4 |
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