endothelin-1 and Emergencies

Pathophysiology of endothelin-1, a vasoconstrictor and a mitogenic peptide, has been extensively investigated in recent years. The authors have examined the main clinical and experimental evidence regarding the involvement of this peptide in some medical emergencies, namely myocardial infarction, stroke and hepato-renal syndrome. Literature data suggest an emerging pathophysiological role for endothelin in such clinical conditions.

Topics: Emergencies; Endothelin-1; Hepatorenal Syndrome; Humans; Myocardial Infarction; Stroke

Contrast-induced acute kidney injury (CI-AKI) is one of the most serious complications in patients who undergo percutaneous coronary intervention (PCI), especially in those with acute coronary syndrome. It has been shown that inflammation may play an important role in the pathophysiology of CI-AKI.. Inflammatory factors may play a predominant role in the prediction of CI-AKI in patients who undergo emergency PCI.. Patients who underwent emergency PCI from 2013 to 2015 were consecutively enrolled and were divided into CI-AKI and non-CI-AKI groups. Logistic analysis was used to identify the risk factors of CI-AKI. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve (AUC) and to establish the optimal cutoff.. A total of 1061 patients were included, and the CI-AKI rate was 5.47% (58/1061). Logistic analysis showed that the white blood cell (WBC) count (odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.018-1.195, P = 0.016), neutrophil (N) count (OR: 1.134, 95% CI: 1.045-1.232, P = 0.003), neutrophil to lymphocyte ratio (NLR) (OR: 1.105, 95% CI: 1.044-1.169, P = 0.001), C-reactive protein (CRP) level (OR: 1.006, 95% CI: 1.001-1.011, P = 0.020), high-sensitivity C-reactive protein (hs-CRP) level (OR: 1.099, 95% CI: 1.020-1.184, P = 0.013), and big endothelin-1 (ET-1) level (OR: 4.030, 95% CI: 1.989-8.165, P < 0.001) were all significant predictors for CI-AKI, as was the left ventricular ejection fraction and diuretic administration. The AUC of the big ET-1 level was the highest (0.793, 95% CI: 0.733-0.853), followed by the NLR (0.708, 95% CI: 0.641-0.774), hs-CRP level (0.705, 95% CI: 0.627-0.782), CRP level (0.684, 95% CI: 0.607-0.761), N count (0.655, 95% CI: 0.584-0.726), WBC count (0.620, 95% CI: 0.544-0.695), and erythrocyte sedimentation rate (0.611, 95% CI: 0.527-0.695).. The WBC count, N count, NLR, CRP level, hs-CRP level, and big ET-1 level are all associated with an increased risk of CI-AKI, and among which, the big ET-1 level, NLR, and the hs-CRP level might have high predictive value for CI-AKI after an emergency PCI.

Topics: Acute Kidney Injury; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Chi-Square Distribution; Contrast Media; Emergencies; Endothelin-1; Female; Humans; Inflammation; Inflammation Mediators; Logistic Models; Lymphocyte Count; Lymphocytes; Male; Middle Aged; Multivariate Analysis; Neutrophils; Odds Ratio; Percutaneous Coronary Intervention; Predictive Value of Tests; Radiography, Interventional; Retrospective Studies; Risk Factors; ROC Curve; Treatment Outcome