Preoperative Fasting Blood Glucose Levels and the Risk of Contrast-induced Nephropathy in Patients With Diabetes and Pre-diabetes Receiving Coronary Arteriography or Percutaneous Coronary Intervention: a Cross-sectional Study

Abstract

\n Background: Diabetes mellitus is an independent risk factor for contrast-induced nephropathy in patients undergoing coronary arteriography /percutaneous coronary intervention. In this study, we evaluated whether preoperative fasting blood glucose levels in diabetic and prediabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN.Methods: We reviewed the incidence of preoperative FBG and postoperative CIN in 3437 patients with CAG/PCI from January 1, 2019, to May 28, 2021 in Tianjin Chest Hospital. Patients were divided into 5 groups based on their preoperative FBG levels. Blood samples were collected at admission and at 48 h and 72 h after operation to determine the serum creatinine levels of patients. P for trend was used to analyze the trend between preoperative FBG levels and the increased risk of CIN. Univariable and multivariable logistic regression analysis were used to exclude the influence of the confounding factors, and some high-risk confounders were selected for subgroup analysis.Results: We found that patients with elevated preoperative FBG levels had higher body mass index (BMI), received PCI more often, and had higher basal SCr levels. The incidence of CIN in the 5 groups of patients was 6.7%, 10.5%, 17.5%, 18.4%, and 23.2%. The trend test was used to determine the odds ratio (OR) (1.000, 1.425, 2.489, 2.704, 3.234). Multivariate logistic regression analysis confirmed that in the main high-risk subgroups including BMI, PCI, hypertension, and age>65, patients with elevated preoperative FBG levels (≥150 mg/dL) had a higher risk of CIN. There was a significant relationship between higher preoperative FBG levels and greater risk for CIN in patients with HbA1c 6.5%-8.0% (P=0.007) and HbA1c 8.0%-9.5% (P=0.011). Conclusions: Results of our cross-sectional study shows that elevated preoperative FBG levels are independently associated with the risk of CIN in diabetic and prediabetic patients undergoing CAG/PCI, and that the incidence of CIN gradually increases with an increase in preoperative FBG levels. Therefore, patients with elevated preoperative FBG at admission should be carefully monitored and more active measures should be taken to prevent CIN.