B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) may represent effective markers for the prediction of contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) undergoing coronary angiography, according to from the results of a systematic review and meta-analysis published in the Journal of Interventional Cardiology.
A total of 9 studies (n=2832) were identified in which patients with ACS who underwent coronary angiography were enrolled. Of 9 studies, 5 all participants had ST-segment elevation myocardial infarction (STEMI). NT-proBNP and BNP were measured in 5 and 4 studies, respectively.
Across studies, the cutoff values for diagnosis of CI-AKI varied between 42.4 and 676 pg/mL for BNP and between 512 and 2320 pg/mL for NT-proBNP.
In an analysis of the diagnostic value of BNP for CI-AKI prediction, the pooled sensitivity value was 0.73 (95% CI, 0.65–0.79) and the pooled specificity value was 0.79 (95% CI, 0.70–0.85). The area under the curve (AUC) of BNP for diagnosing CI-AKI was 0.81 (95% CI 0.77–0.84), indicating a high diagnostic value of this measure.
BNP was found to have a greater diagnostic value in patients with ACS (AUC, 0.85; 95% CI, 0.81-0.88) vs STEMI (AUC, 0.66; 95% CI, 0.62-0.70). In studies solely including patients with ACS, pooled sensitivity was 0.81 (95% CI, 0.74–0.86), and specificity was 0.74 (95% CI, 0.69–0.78).
Study limitations include the variability across studies in CI-AKI definitions and sample sizes as well as substantial heterogeneity in the pooled studies.
“[A]dditional high quality studies are required to find the optimal cutoff value and the diagnostic value of BNP or NT-proBNP in combination with other biomarkers,” noted the study authors.
Li X, Liu C, Mao Z, Qi S, Song R, Zhou F. Brain natriuretic peptide for predicting contrast-induced acute kidney injury in patients with acute coronary syndrome undergoing coronary angiography: A systematic review and meta-analysis. Published September 19, 2020. J Interv Cardiol. doi:10.1155/2020/1035089