Acute kidney injury induces high-sensitivity troponin measurement changes after cardiac surgery

Abstract

BackgroundThe value of cardiac troponin as a risk assessment tool for cardiac disease in the setting of end-stage renal diseases (ESRD) is not equivalent to its value in those with normal renal function. This consideration had not been studied in settings of acute kidney injury (AKI). We aim to explore the diagnostic value of high sensitive troponin T (hsTnT) in the settings of cardiac surgery-induced AKI.MethodsSingle center observational retrospective study. Based on the AKI Network, patients divided into 2 groups, group I without AKI (259 patients) and group II with AKI (100 patients) where serial testing of hsTnT and creatine kinase (CK)-MB were followed in both groups. Patients with (ESRD) were excluded.ResultsThe mean age in our study was 55.1 ± 10.2 years. High association of AKI (27.8%) was found in our patients. Both groups were matched regarding the age, gender, body mass index, the association of diabetes or hypertension, and Euro score. AKI group had significantly higher mortality 5% vs group I 1.1% (p = 0.03). The hsTnt showed a significant sustained rise in the AKI group as compared to the non-AKI group, however CK-MB changes were significant initially but not sustained.The AKI group was more associated with heart failure 17.9% vs 4.9% (p = 0.001); and post-operative atrial fibrillation, 12.4% vs 2.9% (p = 0.005). Lengths of ventilation, stays in ICU and in hospital were significantly higher in the AKI group.ConclusionsUnlike the CK-MB profile, the hsTnT showed significant changes between both groups all over the course denoting possible delayed clearance in patients with AKI.

Prognostic Significance of Serum NGAL and Troponin I against Acute Kidney Injury in Egyptian ICU Patients after Open Heart Surgery: A Pilot Study

“…In a related context, ROC analysis showed low sensitivity, specificity, and accuracy for troponin I. This is in agreement with Omar et al [21], who suggested the possibility of troponin I being an inaccurate marker of perioperative myocardial infarction in patients who develop AKI after cardiac surgery.…”

“…However, the present link between cardiac troponins and the probabilities for chronic kidney disease and end-stage renal disease in cardiovascular disease patients as well as their roles in AKI are still scarce and not well elucidated [20]. A recent study by Omar et al [21] showed a significant rise in cTnT and overcoming CK-MB levels in AKI patients after cardiac surgery, thus postulating their ability to discriminate high risks for AKI among patients with myocardial injury, ischemia, or even myocardial infarction.…”

Utility of Novel Cardiorenal Biomarkers in the Prediction and Early Detection of Congestive Kidney Injury Following Cardiac Surgery

“…Our study is the first to prospectively characterize postoperative c-AKI with serial cardiac and renal biomarkers. Although several studies have evaluated the utility of similar biomarkers for AKI risk stratification in cardiac surgery cohorts [14,18,21,32,35], none have focused on c-AKI, which is truly a cardiorenal syndrome [15]. AKI in the context of RVF results from a complex series of cardiorenal interactions.…”

“…We used conditional logistic regression to assess the association between individual biomarker levels and c-AKI, with and without adjustment for baseline estimated GFR (eGFR), diabetes, and surgery type. These covariates were selected a priori based on the strength of their known association with AKI and RVF in cardiac surgical patients [21,32]. As cases were already matched to controls based on age and sex, these covariates were not included in the model.…”

Intraoperative factors contributory to myocardial injury in high-risk patients undergoing abdominal surgery in a South Indian population

“…[ 17 ] Patients with glomerular filtration rate (eGFR) <30 ml/min have three-fold higher troponin than those with a GFR >60 ml/min. Troponin elevation is seen in patients with acute kidney injury (AKI) also [ 18 ] and doppler evaluation of the resistive index allows early detection. [ 19 ] We had excluded all patients with CKD with a serum creatinine >2.0 mg/dL.…”