Association of the blood urea nitrogen-to-left ventricular ejection fraction ratio with contrast-induced nephropathy in patients with acute coronary syndrome who underwent percutaneous coronary intervention

  • Tuncay Kiris
  • Eyup AvciEmail author
  • Aykan Celik
Nephrology - Original Paper



We investigated the predictive value of the blood urea nitrogen-to-left ventricular ejection fraction ratio (BUNEFr) to evaluate the risk of contrast-induced nephropathy (CIN) in acute coronary syndrome (ACS) patients who were treated with percutaneous coronary intervention (PCI).


A total of 1010 ACS patients undergoing PCI were included in this study. The serum creatinine level was measured before and within 48–72 h of contrast medium administration. Contrast-induced nephropathy was defined as an absolute increase of 0.3 mg/dL or a relative increase of 25% from baseline serum creatinine within 48–72 h of contrast medium exposure. To evaluate the relation between BUNEFr and CIN, the patients were divided into a CIN group and a no-CIN group.


A total of 74 patients developed CIN (7.3%). Patients with CIN were older and had a higher BUNEFr than those without. Multivariate analysis showed that age, hypotension or positive inotrope support, history of stroke, contrast volume, and BUNEFr (OR 10.59, 95% CI 2.803–40.070, p = 0.001) were independent predictors of CIN. For the development of CIN, the AUC of a multivariable model that included hypotension or positive inotrope support, history of stroke, and contrast volume was 0.813 (95% CI 0.758–0.857, p < 0.001). When BUNEFr was added to a multivariable model, the AUC was 0.859 (95% CI 0.814–0.894, z = 3.204, difference p = 0.0014). Moreover, the addition of BUNEFr to a multivariable model was associated with a significant net reclassification improvement estimated at 49.4% (p < 0.001) and an integrated discrimination improvement of 0.044 (p = 0.0138).


The BUNEFr may be a useful new predictor of CIN in ACS patients treated with PCI. The inclusion of BUNEFr in a multivariable model could allow improved risk classification in these patients regarding the development of CIN.


Acute coronary syndrome Contrast-induced nephropathy Blood urea nitrogen to left ventricular ejection fraction 


Compliance with ethical standards

Conflict of interest

Tuncay Kiris, Eyup Avci, and Aykan Celik declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of CardiologyIzmir Katip Celebi University, Ataturk Training and Research HospitalIzmirTurkey
  2. 2.Cardiology DepartmentBalikesir University Faculty of MedicineBalikesirTurkey

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