Proenkephalin improves cardio-renal risk prediction in acute coronary syndromes: the KID-ACS score

作者：Florian A. Wenzl, Peizhi Wang, Mattia Arrigo, Jiří Pařenica, Donald J. L. Jones, Francesco Bruno, Daniel Tarnwski, Oliver Hartmann, Luboš Bouček, Fabian Lang, Slayman Obeid, Andreas Schober, Simon Kraler, Alexander Akhmedov, Florian Kahles, Alexander Schober, Kok Weng Ow, Stefano Ministrini, Giovanni G. Camici, Andreas Bergmann, Luca Liberale, Jiří Jarkovský, Victor Schweiger, Jatinderpal K. Sandhu, Arnold von Eckardstein, Christian Templin, Olivier Müller, Tomáš Ondrúš, Janet-Jacqueline Olic, Marco Roffi, Lorenz Räber, Thong Huy Cao, Carsten Jungbauer, Leong L. Ng, Alexandre Mebazaa, Thomas F. Lüscher · 发表于：European Heart Journal · 年份：2024 · DOI：10.1093/eurheartj/ehae602 · 被引用次数：14 · 研究领域：Acute Kidney Injury Research、Heart Failure Treatment and Management、Chronic Kidney Disease and Diabetes

BACKGROUND AND AIMS: Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndrome (ACS). METHODS: Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n = 4787) and in validation cohorts from the UK (n = 1141), Czechia (n = 927), and Germany (n = 220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. RESULTS: On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI [per log2 increase: adjusted odds ratio 1.53, 95% confidence interval (CI) 1.13-2.09, P = .007] and 30-day mortality (adjusted hazard ratio 2.73, 95% CI 1.85-4.02, P < .001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of .72 (95% CI .68-.76) for in-hospital AKI and .91 (95% CI .87-.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC .73, 95% CI .70-.77; Czechia: AUC .75, 95% CI .68-.81; Germany: AUC .71, 95% CI .55-.87) and 30-day mortality (UK: AUC .87, 95% CI .83-.91; Czechia: AUC .91, 95% CI .87-.94; Germany: AUC .96, 95% CI .92-1.0...