Wenzl, Florian A. and Wang, Peizhi and Arrigo, Mattia and Parenica, Jiri and Jones, Donald J. L. and Bruno, Francesco and Tarnowski, Daniel and Hartmann, Oliver and Boucek, Lubos and Lang, Fabian and Obeid, Slayman and Schober, Andreas and Kraler, Simon and Akhmedov, Alexander and Kahles, Florian and Schober, Alexander and Ow, Kok Weng and Ministrini, Stefano and Camici, Giovanni G. and Bergmann, Andreas and Liberale, Luca and Jarkovsky, Jiri and Schweiger, Victor and Sandhu, Jatinderpal K. and von Eckardstein, Arnold and Templin, Christian and Muller, Olivier and Ondrus, Tomas and Olic, Janet-Jacqueline and Roffi, Marco and Raeber, Lorenz and Cao, Thong H. and Jungbauer, Carsten G. and Ng, Leong L. and Mebazaa, Alexandre and Luescher, Thomas F. (2024) Proenkephalin improves cardio-renal risk prediction in acute coronary syndromes: the KID-ACS score. EUROPEAN HEART JOURNAL, 46 (1). pp. 38-54. ISSN 0195-668X, 1522-9645
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Background and Aims Circulating proenkephalin (PENK) is a stable endogenous polypeptide with fast response to glomerular dysfunction and tubular damage. This study examined the predictive value of PENK for renal outcomes and mortality in patients with acute coronary syndrome (ACS). Methods Proenkephalin was measured in plasma in a prospective multicentre ACS cohort from Switzerland (n = 4787) and in validation cohorts from the UK (n = 1141), Czechia (n = 927), and Germany (n = 220). A biomarker-enhanced risk score (KID-ACS score) for simultaneous prediction of in-hospital acute kidney injury (AKI) and 30-day mortality was derived and externally validated. Results On multivariable adjustment for established risk factors, circulating PENK remained associated with in-hospital AKI [per log2 increase: adjusted odds ratio 1.53, 95% confidence interval (CI) 1.13-2.09, P = .007] and 30-day mortality (adjusted hazard ratio 2.73, 95% CI 1.85-4.02, P < .001). The KID-ACS score integrates PENK and showed an area under the receiver operating characteristic curve (AUC) of .72 (95% CI .68-.76) for in-hospital AKI and .91 (95% CI .87-.95) for 30-day mortality in the derivation cohort. Upon external validation, KID-ACS achieved similarly high performance for in-hospital AKI (Zurich: AUC .73, 95% CI .70-.77; Czechia: AUC .75, 95% CI .68-.81; Germany: AUC .71, 95% CI .55-.87) and 30-day mortality (UK: AUC .87, 95% CI .83-.91; Czechia: AUC .91, 95% CI .87-.94; Germany: AUC .96, 95% CI .92-1.00), outperforming the contrast-associated AKI score and the Global Registry of Acute Coronary Events 2.0 score, respectively. Conclusions Circulating PENK offers incremental value for predicting in-hospital AKI and mortality in ACS. The simple six-item KID-ACS risk score integrates PENK and provides a novel tool for simultaneous assessment of renal and mortality risk in patients with ACS.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | CONTRAST-INDUCED NEPHROPATHY; ACUTE HEART-FAILURE; NATRIURETIC PEPTIDE; SERUM CREATININE; 119-159 PENKID; PLASMA-LEVELS; INJURY; BIOMARKER; DISEASE; PROGNOSIS; Acute coronary syndromes; Acute kidney injury; Mortality risk; Proenkephalin; Risk prediction |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Jul 2025 10:05 |
| Last Modified: | 24 Jul 2025 10:05 |
| URI: | https://pred.uni-regensburg.de/id/eprint/65720 |
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