Admission cardiac and renal biomarkers for early identification of type 1 cardiorenal syndrome after acute myocardial infarction

Abstract

This retrospective study evaluated the diagnostic screening and early identification value of admission baseline cardiac and renal biomarkers for newly developed in-hospital type 1 cardiorenal syndrome (CRS) after acute myocardial infarction (AMI). Baseline samples were collected at emergency admission before the documented onset of renal injury. A total of 150 AMI patients were included, comprising 60 patients who developed incident CRS and 90 AMI controls without renal impairment. Laboratory indicators included cardiac markers (cardiac troponin I [cTnI] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) and renal-related markers including retinol-binding protein (RBP), urea, serum creatinine and spot urinary microalbumin. Multivariate logistic regression adjusted for infarct size, haemodynamic status, baseline renal function, comorbidities and guideline-directed cardiovascular medications, and ROC analysis assessed discriminatory performance. Baseline urea, urinary microalbumin and NT-proBNP were higher, while RBP was lower, in patients who developed CRS (all P < 0.0001). Independently associated indicators included cTnI (OR = 0.628, 95% CI: 0.436–0.903, P = 0.012), RBP (OR = 0.931, 95% CI: 0.883–0.981, P = 0.008), urea (OR = 1.226, 95% CI: 1.039–1.446, P = 0.016) and urinary microalbumin (OR = 1.017, 95% CI: 1.004–1.031, P = 0.013). Urea showed the highest AUC (0.914; sensitivity, 78.5%; specificity, 83.4%). Raw urinary microalbumin showed an AUC of 0.747, and urinary microalbumin showed improved discriminatory performance after urine creatinine calibration and covariate adjustment (AUC = 0.883). Combined assessment of these biomarkers may support diagnostic screening of AMI patients at increased risk of in-hospital CRS.