Abstract: TH-PO0701
Preprocedural Cystatin C and Proenkephalin for Early Risk Stratification of Contrast-Associated AKI After Elective Coronary Angiography
Session Information
- AKI: Prevention, Diagnostics, and Management
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Ozkan, Gulsum, Tekirdag Namik Kemal Universitesi, Tekirdag, Turkey
- Ergin, Badel, Tekirdag Namik Kemal Universitesi, Tekirdag, Turkey
- Celikkol, Aliye, Tekirdag Namik Kemal Universitesi, Tekirdag, Turkey
- Bayrakci, Nergiz, Tekirdag Namik Kemal Universitesi, Tekirdag, Turkey
Background
Contrast-associated acute kidney injury (CI-AKI) remains an important complication after coronary angiography and is still primarily diagnosed using delayed serum creatinine changes. Novel biomarkers reflecting glomerular filtration and tubular stress may improve early risk stratification. We aimed to evaluate the predictive performance of Cystatin C, proenkephalin A (PENK), and urinary Dickkopf-3/creatinine ratio (uDKK3/Cr) in patients undergoing elective coronary angiography.
Methods
This prospective single-center study included 308 elective coronary angiography patients and 83 healthy controls. Cystatin C and PENK were measured before angiography and at 24 hours, while uDKK3/Cr was measured before the procedure. ROC and multivariable logistic regression analyses were performed.
Results
CI-AKI developed in 30 patients (9.7%). Preprocedural Cystatin C and PENK levels were significantly higher in patients who developed CI-AKI. ROC analysis demonstrated modest but significant discriminative ability for both biomarkers (Cystatin C AUC=0.611, p=0.045; PENK AUC=0.630, p=0.019). A preprocedural Cystatin C level >0.487 mg/dL was independently associated with CI-AKI (OR=2.699). In contrast, uDKK3/Cr did not show significant discriminative performance (AUC=0.513, p=0.814). Multivariable analysis identified congestive heart failure, very high Mehran risk category, and elevated preprocedural Cystatin C as independent predictors of CI-AKI. A combined clinical-biomarker model demonstrated high discriminative performance (AUC=0.818).
Conclusion
Preprocedural Cystatin C and PENK may improve early CI-AKI risk stratification when combined with clinical risk assessment in elective coronary angiography patients. Multimarker approaches integrating functional biomarkers with clinical variables may support personalized prevention strategies.
Table 1: ROC Curve Analysis of Mehran Score and Renal Biomarkers for Predicting Contrast-Associated Acute Kidney Injury
| Variable | AUC | Standard Error | Cut-off Value | Sensitivity | Specificity | p value | 95% CI Lower Limit | 95% CI Upper Limit |
| MEHRAN Score | 0.702 | 0.047 | 8.5 | 0.667 | 0.673 | <0.001 | 0.610 | 0.794 |
| Creatinine (T0) | 0.641 | 0.054 | 0.865 | 0.400 | 0.428 | 0.011 | 0.535 | 0.746 |
| BUN (T0) | 0.508 | 0.066 | - | - | - | 0.886 | 0.379 | 0.637 |
| PENK (T0) | 0.630 | 0.051 | 321.679 | 0.567 | 0.568 | 0.019 | 0.531 | 0.729 |
| Cystatin C (T0) | 0.611 | 0.049 | 0.487 | 0.600 | 0.604 | 0.045 | 0.514 | 0.708 |
| (uDKK3/Cr) (T0) | 0.513 | 0.060 | - | - | - | 0.814 | 0.395 | 0.631 |