Florian A Wenzl, Peizhi Wang, Mattia Arrigo, Jiri Parenica, Donald J L Jones, Francesco Bruno, Daniel Tarnowski, Oliver Hartmann, Lubos Boucek, Fabian Lang, Slayman Obeid, Andreas Schober, Simon Kraler, Alexander Akhmedov, Florian Kahles, Alexander Schober, Kok Weng Ow, Stefano Ministrini, Giovanni G Camici, Andreas Bergmann, Luca Liberale, Jiri Jarkovsky, Victor Schweiger, Jatinderpal K Sandhu, Arnold von Eckardstein, Christian Templin, Olivier Muller, Tomas Ondrus, Janet-Jacqueline Olic, Marco Roffi, Lorenz Räber, Thong H Cao, Carsten G Jungbauer, Leong L Ng, Alexandre Mebazaa, Thomas F Lüscher
{"title":"原脑啡肽可改善急性冠状动脉综合征的心肾风险预测：KID-ACS 评分","authors":"Florian A Wenzl, Peizhi Wang, Mattia Arrigo, Jiri Parenica, Donald J L Jones, Francesco Bruno, Daniel Tarnowski, Oliver Hartmann, Lubos Boucek, Fabian Lang, Slayman Obeid, Andreas Schober, Simon Kraler, Alexander Akhmedov, Florian Kahles, Alexander Schober, Kok Weng Ow, Stefano Ministrini, Giovanni G Camici, Andreas Bergmann, Luca Liberale, Jiri Jarkovsky, Victor Schweiger, Jatinderpal K Sandhu, Arnold von Eckardstein, Christian Templin, Olivier Muller, Tomas Ondrus, Janet-Jacqueline Olic, Marco Roffi, Lorenz Räber, Thong H Cao, Carsten G Jungbauer, Leong L Ng, Alexandre Mebazaa, Thomas F Lüscher","doi":"10.1093/eurheartj/ehae602","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"38-54"},"PeriodicalIF":37.6000,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695896/pdf/","citationCount":"0","resultStr":"{\"title\":\"Proenkephalin improves cardio-renal risk prediction in acute coronary syndromes: the KID-ACS score.\",\"authors\":\"Florian A Wenzl, Peizhi Wang, Mattia Arrigo, Jiri Parenica, Donald J L Jones, Francesco Bruno, Daniel Tarnowski, Oliver Hartmann, Lubos Boucek, Fabian Lang, Slayman Obeid, Andreas Schober, Simon Kraler, Alexander Akhmedov, Florian Kahles, Alexander Schober, Kok Weng Ow, Stefano Ministrini, Giovanni G Camici, Andreas Bergmann, Luca Liberale, Jiri Jarkovsky, Victor Schweiger, Jatinderpal K Sandhu, Arnold von Eckardstein, Christian Templin, Olivier Muller, Tomas Ondrus, Janet-Jacqueline Olic, Marco Roffi, Lorenz Räber, Thong H Cao, Carsten G Jungbauer, Leong L Ng, Alexandre Mebazaa, Thomas F Lüscher\",\"doi\":\"10.1093/eurheartj/ehae602\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":11976,\"journal\":{\"name\":\"European Heart Journal\",\"volume\":\" \",\"pages\":\"38-54\"},\"PeriodicalIF\":37.6000,\"publicationDate\":\"2025-01-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695896/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/eurheartj/ehae602\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/eurheartj/ehae602","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Proenkephalin improves cardio-renal risk prediction in acute coronary syndromes: the KID-ACS score.
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.
期刊介绍：
The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters.
In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.
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