Background: Coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) face the risk of contrast-induced nephropathy (CIN).

Aim: To explore the combined predictive value of fibrinogen (FIB) and antithrombin-III (AT-III) in identifying CIN risk in CAD patients undergoing PCI.

Methods: A total of 400 patients with ischemic heart diseases (IHD) undergoing PCI were enrolled in the study. Baseline assessments included demographic information, clinical parameters, and laboratory investigations, covering triglycerides, total cholesterol, HDL-C, LDL-C, albumin, glucose, FIB, neutrophil-to-lymphocyte ratio, AT-III, cystatin-C, serum uric acid, platelet-to-lymphocyte ratio, eGFR, and pre-procedural serum creatinine levels to establish baseline kidney function.

Results: Out of the 400 patients who underwent PCI, 32 (8%) developed acute kidney injury (AKI). Multivariate analysis identified several factors as independent predictors for AKI in PCI patients, including higher BMI, lower triglyceride levels, lower albumin levels, elevated glucose levels, and increased fibrinogen levels. Fibrinogen exhibited a high predictive value for AKI (AUC: 0.829) with an optimal cut-off value of 2.91 g/l, sensitivity of 93.7%, and specificity of 56.2%. Antithrombin III had an AUC of 0.661, with an optimal cut-off value of 85.6%, sensitivity of 62.5%, and specificity of 74.7%. Combining FIB and AT-III improved predictive accuracy, yielding an optimal cut-off value of 0.0923, with a diagnostic sensitivity of 75% and specificity of 79.3%.

Conclusion: The combined assessment of FIB and AT-III significantly enhances the predictive accuracy of CIN. Elevated FIB levels and decreased AT-III levels may indicate an increased risk of developing CIN.