BACKGROUND/AIMS: The pathophysiology of acute kidney injury (AKI) in ST-elevation myocardial infarction (STEMI) patients remains poorly explored. The involvement of the nitric oxide (NO) pathway has been demonstrated in experimental ischemic AKI. The aim of this study was to assess the predictive value of circulating biomarkers of the NO pathway for AKI in STEMI patients. METHODS: Four hundred and twenty-seven STEMI patients treated with primary percutaneous coronary intervention were included. The primary end point was AKI. Biomarkers of the NO pathway (plasma superoxide dismutase [SOD], uric acid, nitrite/nitrate [NOx], neopterin) as well as cardiac biomarkers (B-type natriuretic peptide [BNP] and troponin) were sampled 12 h after admission. The predictive value of circulating biomarkers was evaluated in addition to the multivariate clinical model. RESULTS: AKI developed in 8.9% of patients. The 3-month mortality was significantly higher in patients with AKI (34.2 vs. 4.1%; p < 0.001). SOD, uric acid, NOx, neopterin, BNP and troponin were significantly associated with the development of AKI (area under curve [AUC]-receiver operating curve [ROC] ranging between 0.70 and 0.81). In multivariate analysis cardiogenic shock, neopterin, NOx and troponin were independent predictors of AKI. AUC-ROC of the association of multibiomarkers and clinical model was 0.90 and outperformed the predictive value of the clinical model alone. OR of NOx ≥45 µmol/L was 8.0 (95% CI 3.1-20.6) for AKI. CONCLUSION: Biomarkers of the NO pathway are associated with the development of AKI in STEMI patients. These results provide insights into the pathophysiology of AKI and may serve at developing preventing strategies for AKI targeting this pathway.

Department of Anaesthesiology and Critical Care and Burn Unit APHP Saint Louis Lariboisière University Hospitals Paris France

Department of Anaesthesiology and Intensive Care St Anne's University Hospital Brno Czechia

Department of Biochemistry Faculty of Medicine Masaryk University Brno Czechia

Department of Biochemistry University Hospital Brno Brno Czechia

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czechia

Department of Laboratory Methods Faculty of Medicine Masaryk University Brno Czechia

Department of Translational Physiology Academic Medical Center Amsterdam The Netherlands

F CRIN INI CRCT Network Nancy France

Faculty of Medicine Masaryk University Brno Czechia

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czechia

Institute of Pathological Physiology Faculty of Medicine Masaryk University Brno Czechia

Intensive Care Research International Clinical Research Centre Brno Czechia

U 942 INSERM Paris France

Université Paris Diderot PRES Sorbonne Paris Cité Paris France

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