Objectives To investigate the level of IL-18 in patients underwent coronary angiography (CAG) and/or Percutaneous coronary intervention (PCI) before and after operation and to explore IL-18 value in predicting of contrast-induced nephropathy (CIN). To observe the incidence of contrast-induced nephropathy (CIN) in three groups: Hydration with the sodium chloride, the vitamin C besides hydration with the sodium chloride and Danhong Injection combined with vitamin C besides hydration with the sodium chloride and to seek effective measure for prevention of CIN.
Methods A total of 180 patients underwent CAG and/or PCI were from the department of Cardiology were randomly divided into three groups: the sodium chloride group (the control group consisted of 60 cases), the vitamin C group (the treated group consisted of 60 cases), and the Vitamin C and DanHong group (the other treated group consisted of 60 cases), The sodium chloride group were given 0.9% sodium chloride with the speed of 1 ml/(kg·h) from 6h before operation to 12h after operation; Vitamin C group were given Vitamin C 3.0 g by intravenous infusion 2∼4h before operation and oral Vitamin C 1.0 g respectively on following 2 days after operation on the basis of the sodium chloride group treatment, the total dose of the Vitamin C is 5 g; the Vitamin C and DanHong group were given additional 40 ml DanHong Injection in 0.9% sodium chloride 1 hour before PCI on the basis of the Vitamin C group treatment.
The renal function of all patients were accessed before and 1-2 days after operation. The estimated GFR was calculated using the modified Modification of Diet in Renal Disease equation for Chinese patients. And 15ml urine was collected before and 2h, 6h, 12h, 24h, 48h after operation IL-18 level was measured by Enzyme-linked immunosorbent assay (ELISA).
Results There were 16 cases of CIN of the 180 patients, The incidence of CIN was 8.9% (9/60) in sodium chloride group while 15.0% (6/60) in Vit C group and 1.7% (1/60) in DanHong and Vitamin C group. There was a significant difference in the incidence of CIN between the three groups (P < 0.05). The prevalence of CIN is much lower in DanHong and Vitamin C group than in sodium chloride group and Vitamin C group but there was not a significant difference between sodium chloride group and Vitamin C group.
There was a significant difference (p < 0.05) between the urine IL-18 level of 6h, 12h and 24 h (1000.47 ± 248.79, 1154.13 ± 279.55, 1047.56 ± 281.65) pg/ml after operation and the urine IL-18 level (646.62 ± 243.59) before operation. There was not a significant difference between the Scr level at 24h after operation and before the operation. CIN can be diagnosed by urine IL-18 at least 24h ahead Scr. The area under the ROC curve of urine IL-18 12h after operation is 0.811, confidence interval of AUC 95% is (0.735, 0.888). Binary logistic shows: advanced age, diabetic mellitus, left heart insufficiency, the level of Scr and the lower eGFR level before operation, does of contrast agent and the ratio of the does of contrast agent to eGFR are the independent risk facts of CIN.
Conclusions IL-18 may be a better and earlier biomarker for prediction of CIN than Scr, and provide new ideas for early diagnosis of CIN. Vitamin C and DanHong injection with hydration more effective in reducing the prevalence of CIN in patients undergoing CAG and/or PCI.
Given Vitamin C besides hydration in the short time can not further reduce the prevalence of CIN.