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Multicenter Study
. 2023 Apr 20;22(1):92.
doi: 10.1186/s12933-023-01831-6.

Long- and very long-chain ceramides are predictors of acute kidney injury in patients with acute coronary syndrome: the PEACP study

Lianjing Liang  1 , Dongze Li  1 , Rui Zeng  1 , Haihong Zhang  1 , Lin Lv  1 , Wei Wei #  2 , Zhi Wan #  1
Affiliations
Multicenter Study

Long- and very long-chain ceramides are predictors of acute kidney injury in patients with acute coronary syndrome: the PEACP study

Lianjing Liang et al. Cardiovasc Diabetol. .

Abstract

Background: Acute kidney injury (AKI) can be caused by multiple factors/events, including acute coronary syndrome (ACS). Ceramides are involved in atherosclerosis progression, cardiovascular events, and renal damage. Almost no studies have been conducted on the relationship between ceramide concentrations and AKI events. Therefore, we evaluated the association between plasma ceramide level at admission and AKI in patients with ACS undergoing percutaneous coronary intervention.

Methods: We enrolled 842 ACS patients from the Prospective Multicenter Study for Early Evaluation of Acute Chest Pain. AKI was defined using the criteria from the 2012 Kidney Disease: Improving Global Outcomes. Eleven C16-C26 ceramides were measured using the high-performance liquid chromatography interfaced to tandem mass spectrometer procedure. Logistic regression models were used to evaluate relationships between ceramides and AKI risk. The area under the receiver operating characteristic curves (AUC) was used to evaluate differences between ceramides.

Results: Overall, 139 (16.5%) patients developed AKI during hospitalisation. Patients who developed AKI had higher levels of Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/20:0), Cer(d18:1/21:0), Cer(d18:1/24:1), and Cer(d18:1/24:2) than patients who did not (P < 0.05). In risk-factor adjusted logistic regression models, these ceramides were independently associated with AKI risk (P < 0.05). Cer(d18:1/24:2) had the highest odds ratio of 3.503 (Q4 vs. Q1, 95% confidence interval: 1.743-7.040, P < 0.001). Ceramides had AUCs of 0.581-0.661 (P < 0.001) for AKI. Each ceramide combined with the Mehran risk score (AUC: 0.780) had AUCs of 0.802-0.808, greater than the Mehran risk score alone.

Conclusion: Long-chain and very-long-chain ceramide levels may help determine the high AKI risk beyond traditional assessments.

Keywords: Acute coronary syndrome; Acute kidney injury; Ceramides; Percutaneous coronary intervention.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow-process diagram. ED emergency department, PCI percutaneous coronary intervention
Fig. 2
Fig. 2
Correlation between all eleven ceramides and common prognostic factors in patients with acute coronary syndrome. The value in the heat map is the correlation coefficient. * < 0.05; ** < 0.001; *** < 0.0001. GRACE Global Registry of Acute Coronary Events, WBC white blood cell count, BUN Blood urea nitrogen, HDL-C high-density lipoprotein, LDL-C low-density lipoprotein, eGFR estimated glomerular filtration rate, hs-CTnT high sensitive cardiac troponin T, NT-proBNP N-terminal pro-brain natriuretic peptide, NLR neutrophil to lymphocyte ratio
Fig. 3
Fig. 3
Unadjusted and adjusted OR of eleven ceramides for AKI. Models were adjusted by age, sex (male vs. female), systolic blood pressure, heart rate, body mass index, statin (yes vs. no), hypertension (yes vs. no), diabetes (yes vs. no), hyperlipidemia (yes vs. no), Killip class (I vs. II vs. III vs. IV), white blood cell count, low-density lipoprotein cholesterol, total cholesterol, triglyceride, estimated glomerular filtration rate, high sensitive cardiac troponin T, N-terminal pro-brain natriuretic peptide, and Mehran risk score. OR odds, ratio, CI confidence interval, AKI acute kidney injury
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