Endothelial activation and stress index (EASIX) as a predictor of acute kidney injury in patients undergoing transcatheter aortic valve replacement: A retrospective cohort study

Transcatheter aortic valve replacement (TAVR) is being performed in increasingly complex, high-risk cohorts, and contrast-induced nephropathy (CIN) remains a major determinant of morbidity and mortality. The endothelial-damage score EASIX (lactate dehydrogenase × creatinine/platelet count) is a validated prognostic index in hematology and critical care but has never been explored after TAVR. We retrospectively analyzed 130 consecutive severe AC patients (mean age 76.8 ± 8.4 years; 47.8% male) who underwent transfemoral TAVR (February 2019-March 2021). CIN was defined as a ≥25% or ≥0.5 mg/dL creatinine rise within 72 hours. The predictive value of EASIX was assessed with receiver operating characteristic analysis and multivariable logistic regression. CIN occurred in 15.4% (n = 20). Baseline EASIX was higher in CIN+ vs CIN- (2.92 ± 1.28 vs 1.33 ± 1.30; P < .001). An EASIX threshold ≥ 1.904 predicted CIN with 90.3% sensitivity and 86.2% specificity (area under the curve 0.91; P < .001). In multivariable analysis, EASIX (OR 2.62; P = .023), contrast volume, and baseline eGFR independently predicted CIN. EASIX, obtainable from routine laboratories, is an independent, high-performance predictor of CIN after TAVR and may facilitate pre-procedural risk stratification.