Diagnosis of cardiac surgery-associated acute kidney injury: differential roles of creatinine, chitinase 3-like protein 1 and neutrophil gelatinase-associated lipocalin: a prospective cohort study

Abstract

BackgroundA common and serious complication of cardiac surgery prompting early detection and intervention is cardiac surgery-associated acute kidney injury (CSA-AKI). Urinary chitinase 3-like protein 1 (UCHI3L1) was found to predict AKI associated with critical illness in adults. Our aims were therefore to evaluate whether UCHI3L1 can also be used to predict AKI associated with elective cardiac surgery in adults, and to compare this predictive ability with that of urinary neutrophil gelatinase-associated lipocalin (UNGAL), more frequently assessed early serum creatinine (SCr) measurements, and various two-biomarker panels.MethodsThis was a single-centre prospective cohort study at the eight-bed cardiac surgery ICU of Ghent University Hospital. AKI was diagnosed and classified according to the Kidney Disease|Improving Global Outcomes definitions for the diagnosis and staging of AKI, which are based on SCr and urine output (UO). Of the 211 enrolled elective cardiac surgery patients, we included 203 patients who had no AKI pre-operatively and at time of post-operative ICU admission (t1) in the primary endpoint analysis (i.e. AKI stage ≥1 within 48 h after t1), while 210 patients without AKI stage ≥2 pre-operatively and at t1 were included in the secondary endpoint analysis (i.e. AKI stage ≥2 within 12 h after t1). Systemic and/or urine concentrations of Cr, CHI3L1 and NGAL were measured more frequently than SCr in routine early post-operative ICU practice. UO was monitored hourly in the ICU.ResultsWithin 48 h after t1, 46.8% of the patients had developed AKI (70.5% stage 1, 20.0% stage 2 and 9.5% stage 3). In the early post-operative period, only SCr was a good predictor of AKI within 48 h after t1 (primary endpoint). SCHI3L1 combined with either UCHI3L1 or UNGAL was a good predictor of AKI stage ≥2 within 12 h after t1 (secondary endpoint). However, SCr and its absolute difference from pre-operative to early measures after surgery outperformed these combinations.ConclusionsWe found that more frequent assessment of the functional biomarker SCr in the early post-operative ICU period (first 4 h) after elective cardiac surgery in adult patients had good to excellent predictive value for CSA-AKI, indicating that routine SCr assessment must become more frequent in order to detect AKI more early. This performance was in contrast with the inadequate predictive value of the urinary renal stress or damage biomarkers UCHI3L1 and UNGAL.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0251-z) contains supplementary material, which is available to authorized users.

Implementation of Proteomics Biomarkers in Nephrology: From Animal Models to Human Application?

“…In a subsequent study, the group reported the association of urinary CHI3L1 to the development of AKI after cardiac surgery involving 211 patients. However, in this study urinary CHI3L1 was not predictive of AKI . The biological roles of CHI3L1 have been for a long time particularly enigmatic, but data has shown that intrarenal macrophage CHI3L1 plays a key role in promoting tubular cell survival after renal I/R injury in mice via PI3K‐ and IL‐13 receptor α2‐dependent signaling .…”

Urinary cell cycle arrest biomarkers and chitinase 3-like protein 1 (CHI3L1) to detect acute kidney injury in the critically ill: a post hoc laboratory analysis on the FINNAKI cohort

“…In this multicenter validation study, we found that uCHI3L1 was markedly increased in general ICU patients who developed AKI stage 2 or 3 within a 24-h [15]. This study and previous studies on uCHI3L1 have demonstrated its use as a biomarker for diagnosis of AKI, and this with comparable performance to uNGAL and NephroCheck Risk® [8,9,[17][18][19]. CHI3L1 may also provide mechanistic insights in injury and repair mechanisms in the kidney.…”

“…With the Astute140® Meter, we measured the concentrations of urinary TIMP-2, urinary IGFBP7, and NephroCheck Risk® by a fluorescent immunoassay technique (NephroCheck® Test, Astute Medical, San Diego, CA, USA). Details on these laboratory analyses were recently described [9].…”

“…Recently, we showed in a single-center prospective cohort study that urinary chitinase 3-like protein 1 (uCHI3L1) is a promising AKI biomarker in ICU patients when compared to urinary neutrophil gelatinaseassociated lipocalin (uNGAL) [8]. A subsequent study by our group in adult patients who underwent elective cardiac surgery demonstrated that in this specific setting, both uCHI3L1 and uNGAL showed inadequate predictive value for AKI [9].…”

The correlation of post-operative acute kidney injury and perioperative anaemia in patients undergoing cardiac surgery with cardiopulmonary bypass

“…According to the severity, AKI is classified into (1) severe (serum creatinine level increase >3 times of the initial value), requiring kidney replacement therapy, (2) moderate (serum creatinine level 2-3 times higher than the initial value), and (3) mild (serum creatinine level increases up to 1.5 times from the initial value) postoperative AKI. However, serum creatinine concentration is not an accurate and early indicator of the kidney condition, thus it is often suggested to use newer biomarkers instead, which allow earlier diagnosis and detect injuries of a minor degree (4). AKI can be diagnosed by serum level of neutrophil gelatinase-associated lipocalin (NGAL), which is a biomarker reflecting early kidney injury in the distal nephrons (5).…”