Association of Serum Cholinesterase with Contrast-Associated Acute Kidney Injury and Adverse Outcomes in Percutaneous Coronary Intervention Patients

Li-Wei Zhang,1– 3,* Ji-Lang Zeng,4,* Chang-Xi Wang,1– 3,* Man-Qing Luo,5 Kai-Yang Lin,1– 3 Yansong Guo1– 3 1Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, People’s Republic of China; 2Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, People’s Republic of China; 3Fujian Heart Failure Center Alliance, Fuzhou, People’s Republic of China; 4Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, People’s Republic of China; 5Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yansong Guo, Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, 134 East Street, Gulou District, Fuzhou, Fujian, 350001, People’s Republic of China, Fax +86-591-87557768, Email [email protected] Kai-Yang Lin, Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, 134 East Street, Gulou District, Fuzhou, Fujian, 350001, People’s Republic of China, Fax +86-591-87557768, Email [email protected]: Serum cholinesterase (SChE) is a pleiotropic biomarker that is closely related to malnutrition, systemic inflammation, and hepatocyte injury. However, the utility of SChE in patients undergoing percutaneous coronary intervention (PCI) remains unclear. This study sought to investigate the associations between SChE and contrast-associated acute kidney injury (CA-AKI) as well as mortality in patients undergoing PCI.Patients and Methods: We retrospectively observed 1,696 patients at a tertiary hospital from January 2016 to December 2018. CA-AKI was defined as an increase in serum creatinine ≥ 50% or 0.3 mg/dL within 48 h after contrast medium exposure.Results: During hospitalization, 198 patients (11.7%) developed CA-AKI. Restricted cubic spline (RCS) and receiver operating characteristic (ROC) analysis demonstrated that SChE levels were negatively correlated with CA-AKI and had predictive value (AUC, 0.655; 95% CI, 0.613– 0.697). Multivariable regression analysis showed that patients in low-SChE group (≤ 7.5 kU/L) had a higher risk of developing CA-AKI (OR, 1.80; 95% CI, 1.21– 2.67) compared to those in the high-SChE group (> 7.5 kU/L). Regarding prognosis, SChE levels were also negatively associated with long-term mortality and were capable of predicting 90-day mortality (AUC, 0.826; 95% CI, 0.760– 0.892). Patients in the low-SChE group had significantly higher long-term mortality risks (HR, 2.56; 95% CI, 1.55– 4.32). Mediation analyses further indicated that CA-AKI partially mediated the relationship between SChE and short-term mortality, with a mediation proportion of 12.79%.Conclusion: Low SChE is an independent risk factor for CA-AKI and a poor prognosis after PCI. Short-term mortality associated with SChE levels is partially mediated through the occurrence of CA-AKI. It is recommended that clinicians evaluate SChE levels prior to PCI and adjust hydration therapy according to SChE levels.Keywords: serum cholinesterase, percutaneous coronary intervention, contrast-associated acute kidney injury, prognosis, mediation analyses