Association between fasting stress hyperglycemia ratio and contrast-induced acute kidney injury in coronary angiography patients: a cross-sectional study

Abstract

Aims: Stress hyperglycemia ratio (SHR), an emerging indicator of critical illness, exhibits a significant association with adverse cardiovascular outcomes. The primary aim of this research endeavor is to evaluate the association between fasting SHR and contrast-induced acute kidney injury (CI-AKI).

Methods: This cross-sectional study comprised 3,137 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI). The calculation of fasting SHR involved dividing the admission fasting blood glucose by the estimated mean glucose obtained from glycosylated hemoglobin. CI-AKI was assessed based on elevated serum creatinine (Scr) levels. To investigate the relationship between fasting SHR and the proportion of SCr elevation, piecewise linear regression analysis was conducted. Modified Poisson's regression analysis was implemented to evaluate the correlation between fasting SHR and CI-AKI. Subgroup analysis and sensitivity analysis were conducted to explore result stability.

Results: Among the total population, 482 (15.4%) patients experienced CI-AKI. Piecewise linear regression analysis revealed significant associations between the proportion of SCr elevation and fasting SHR on both sides (≤ 0.8 and > 0.8) [β = -12.651, 95% CI (-23.281 to -2.022), P = 0.020; β = 8.274, 95% CI (4.176 to 12.372), P < 0.001]. The Modified Poisson's regression analysis demonstrated a statistically significant correlation between both the lowest and highest levels of fasting SHR and an increased incidence of CI-AKI [(SHR < 0.7 vs. 0.7 ≤ SHR < 0.9) β = 1.828, 95% CI (1.345 to 2.486), P < 0.001; (SHR ≥ 1.3 vs. 0.7 ≤ SHR < 0.9) β = 2.896, 95% CI (2.087 to 4.019), P < 0.001], which was further validated through subgroup and sensitivity analyses.

Conclusion: In populations undergoing CAG or PCI, both lowest and highest levels of fasting SHR were significantly associated with an increased occurrence of CI-AKI.

Keywords: contrast-induced acute kidney injury; coronary angiography; diabetes; fasting stress hyperglycemia ratio; serum creatinine elevation.

Figure 1

Flowchart of patient enrollment. CAG, coronary angiography; PCI, percutaneous coronary intervention; CAD, coronary artery disease; HbA1c, glycosylated hemoglobin A1c; FBG, fasting blood glucose; Scr, serum creatinine; NYHA, New York Heart Association; LVEF, left ventricular ejection fraction; CI-AKI, contrast-induced acute kidney injury.

Figure 2

The population distribution histogram and RCS curve. (A) Distribution of population and the incidence of CI-AKI based on fasting SHR categories. The changing trend in the incidence of CI-AKI is illustrated by the blue dashed line. The bar plots presented the distribution of the population across different categories of fasting SHR. Left axis, population count (patients); right axis, incidence of CI-AKI (%). (B) RCS analysis is employed to investigate the non-linear relationship between fasting SHR and CI-AKI. The relative risk of fasting SHR for CI-AKI is represented by the solid blue line, while the shaded area surrounding the line represents the 95% CI of the curve. SHR, stress hyperglycemia ratio; CI-AKI, contrast-induced acute kidney injury; RCS, restricted cubic spline; CI, confidence interval.

Figure 3

RCS analyses between fasting SHR and CI-AKI in different subgroups. RCS analyses were performed by stratifying the population into subgroups based on diabetes (yes (A) or no (B)) and HbA1c levels (> 6.0% (C) or ≤ 6.0% (D)); The relative risk of fasting SHR for CI-AKI is represented by the solid blue line, while the shaded area surrounding the line represents the 95% CI of the curve. CI-AKI, contrast-induced acute kidney injury; CI, confidence interval; RCS, restricted cubic spline; SHR, stress hyperglycemia ratio.