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Background: We previously developed a clinical/proteomics panel for predicting procedural acute kidney injury (AKI) and now examine its performance in those with diabetes (DM). Methods: We measured 109 biomarkers in blood from patients undergoing coronary angiography. Procedural AKI defined as increase in serum creatinine ≥0.3 mg/dL, increase in serum creatinine of ≥50%, or documented oliguria ≤7 days after procedure. Clinical and biomarker predictors of AKI identified using least-angle regression; a final prognostic model was developed with LASSO; the model was then measured in those with DM. Results: Besides DM, 5 predictors were in the final model: 3 (blood urea nitrogen to creatinine ratio, C-reactive protein and osteopontin) had positive association, while 2 (CD5 antigen-like and Factor VII) had negative association with AKI risk. Among 217 patients with DM, 18 (8.3%) developed AKI. The final model had an AUC of 0.87 for predicting procedural AKI (P Conclusions: We describe a clinical and proteomics-supported biomarker model with high sensitivity/NPV for AKI in patients with DM following coronary angiography. Disclosure N.E. Ibrahim: Other Relationship; Self; Novartis Pharmaceuticals Corporation. C.P. McCarthy: None. S. Shrestha: None. H. Gaggin: Other Relationship; Self; Dr. Gaggin has received research grant support from Roche Diagnostics, Jana Care, Ortho Clinical, Novartis; consulting income from Merck, Roche Diagnostics; research payments for clinical endpoint com. R. Mukai: None. C.A. Magaret: Consultant; Self; Prevencio. R.F. Rhyne: Board Member; Self; Prevencio. Employee; Self; Prevencio. Stock/Shareholder; Self; Prevencio. J. Januzzi: Consultant; Self; Abbott, Roche Diagnostic USA. Research Support; Self; Abbott, Prevencio, Quest Diagnostics, Roche Diagnostic USA. Funding Prevencio, Inc.

Background: Patients with diabetes mellitus (DM) are at increased risk for prevalent coronary artery disease (CAD) and incident major adverse cardiac events (MACE) such as cardiovascular death, myocardial infarction, and stroke. Prediction of risk in those with DM may be challenging. Using unbiased proteomics we recently described biomarker panels to predict prevalent CAD (HART-CAD) and incident MACE (HART-CVE; both Prevencio, Kirkland, WA) in unselected patients undergoing diagnostic coronary angiography. In this study, we sought to compare accuracy of these panels in patients with and without DM. Methods: The HART-CAD panel includes 2 clinical variables (male sex and prior PCI) and 4 biomarkers: adiponectin, apolipoprotein CI, kidney injury molecule 1 (KIM 1), and midkine. The HART-CVE panel includes 4 biomarkers (amino-terminal pro-B type natriuretic peptide, KIM 1, osteopontin, and tissue inhibitor of matrix metalloproteinase-1). These panels were derived in 167 DM and 482 non-DM patients; performance of each was validated in a second cohort of patients (N=278) with and without DM. Results: In patients with DM, the HART-CAD panel had excellent performance for prediction of coronary stenosis ≥ 70%, with area under the curve (AUC) of 0.81 (p Conclusion: Previously described multivariate proteomic biomarker panels effectively predict prevalent CAD and risk for incident MACE in at-risk patients with DM. Disclosure S. Shrestha: None. C.P. McCarthy: None. N.E. Ibrahim: None. R. van Kimmenade: None. H. Gaggin: Research Support; Self; Roche Diagnostics Corporation, Portola. Consultant; Self; Roche Diagnostics Corporation, Amgen Inc., Ortho clinical. Other Relationship; Self; EchoSense, Radiometer. R. Mukai: None. C.A. Magaret: Consultant; Self; Prevencio. G. Barnes: Employee; Self; Prevencio. R.F. Rhyne: None. J. Januzzi: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc.. Board Member; Self; Jana Care Inc.. Research Support; Self; Prevencio.