Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery—A prospective cohort study*

Haase-Fielitz, Anja; Bellomo, Rinaldo; Devarajan, Prasad; Story, David A; Matalanis, George; Dragun, Duska; Haase, Michael

doi:10.1097/ccm.0b013e318195846e

Cited by 379 publications

(317 citation statements)

References 21 publications

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“…Plasma CysC is a robust marker of GFR and it is notable that in our cohort and the one described by Haase-Fielitz et al (23,24) CysC values were elevated preoperatively in patients who would later develop AKI as compared with those who would not. This suggests that at least part of the predictive capacity of plasma CysC is a carryover effect of the well-known association between low GFR at baseline and subsequent AKI.…”

Section: Discussionmentioning

confidence: 69%

“…In a population of critically ill patients, serum cystatin C predated the identification of creatinine-based AKI by 1 to 2 days (22). In a recently published study of 100 patients undergoing CPB, the predictive capacity of plasma CysC on arrival in the ICU was excellent (AUC 0.83, 95% CI 0.68 to 0.98) for the subsequent development of AKI (23). The reasons for the discrepancy between these findings as compared with ours and the work of Koyner et al (20) are not entirely clear.…”

Section: Discussionmentioning

confidence: 99%

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Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Wald

Liangos

Perianayagam

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:Little is known about the performance of plasma cystatin C (CysC) in patients undergoing cardiopulmonary bypass (CPB) and its utility in the early diagnosis of acute kidney injury (AKI). In this post hoc analysis, the goal was to determine whether plasma cystatin C, measured 2 hours after the conclusion of CPB, is a reliable marker of AKI.Design, setting, participants, & measurements: Plasma CysC was measured in 150 patients undergoing CPB at the following times: preoperatively, 2 hours after the conclusion of CPB, postoperative day 1, and postoperative day 2. Plasma CysC levels were related to the development of AKI as defined by an increase in serum creatinine of >50% or >0.3 mg/dl from baseline up to 3 days postoperative. Mixed linear models were used to evaluate the relationship of serial plasma CysC values with AKI. The discriminatory capacity of plasma CysC was estimated using receiver operating characteristic curves. Logistic regression was utilized to assess the adjusted relationship between plasma CysC and subsequent AKI.Results: AKI developed in 47 (31.3%) patients. Plasma CysC was higher at all times among patients who developed AKI compared with those who did not (P < 0.0001). The discriminatory capacity of plasma CysC measured preoperatively and 2 hours after the conclusion of CPB was modest.Conclusions: Serial measures of plasma CysC are highly correlated with the development of AKI. However, the discriminatory capacity of plasma CysC as an early marker of AKI remains limited.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Wald

Liangos

Perianayagam

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…24 Similarly, serum NGAL and cystatin C have been found to be promising diagnostic biomarkers for early detection of AKI in a range of clinical settings, including cardiac surgery, contrast-induced nephropathy, and sepsis. [25][26][27][28][29] Acute kidney injury prognosis…”

Section: Acute Kidney Injury Predictionmentioning

confidence: 99%

Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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“…NGAL is produced and secreted into the urine in response to ischemic kidney damage and is therefore a promising early indicator of tubulointerstitial damage [4,5]. Recent clinical studies show that U-NGAL reflect acute renal damage early [6][7][8][9] but may also signal chronic renal damage [10][11][12][13]. When mild to moderate increases in U-NGAL concentrations are expected it is of essence to know whether U-NGAL should be measured as absolute values or as a ratio to urinary Creatinine (U-Cr).…”

Section: Introductionmentioning

confidence: 99%

Day-to-day variation of urinary NGAL and rational for creatinine correction

Helmersson‐Karlqvist

Ärnlöv

Larsson

2013

Clinical Biochemistry

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Day-to-day variation of urinary NGAL and rational for creatinine correction. Objectives: Clinical studies evaluating the new tubular biomarker urinary neutrophil gelatinase-associated lipocalin (U-NGAL) in urine increase and there is no consensus whether absolute U-NGAL concentrations or urinary NGAL/creatinine (U-NGAL/Cr) ratios should be used when chronic tubular dysfunction is studied. The aim was to study the biological variation of U-NGAL in healthy subjects and the rational for urinary Creatinine (U-Cr) correction in two different study samples. Design and Methods:To study biological variation of U-NGAL and U-NGAL/Cr ratio and the association between U-NGAL and U-Cr in healthy subjects 13 young males and females (median age 29 years) collected morning urine in 10 consecutive days. Additionally, a random subsample of 400 males from a population-based cohort (aged 78 years) collecting 24-hour urine during one day was studied. Results:The calculated biological variation for absolute U-NGAL was 27% and for U-NGAL/Cr ratio 101%. Absolute U-NGAL increased linearly with U-Cr concentration (the theoretical basis for creatinine adjustment) in the older males (R = 0.19, P<0.001) and with borderline significance in the young adults (R = 0.16, P = 0.08). The U-NGAL/Cr ratio was, however, negatively associated with creatinine in the older males (R = -0.14, P<0.01) and in the young adults (R = -0.16, P = 0.07) indicating a slight "overadjustment". Conclusions:The study provide some support for the use of U-NGAL/Cr ratio but the rather large biological variation and risk of possible overadjustment need to be considered. Both absolute U-NGAL and U-NGAL/Cr ratios should be reported for the estimation of chronic tubular dysfunction.

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Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery—A prospective cohort study*

Abstract: Early postoperative measurement of plasma NGAL was of good value in identifying patients who developed AKI after adult cardiac surgery. Plasma NGAL and serum cystatin C were superior to conventional biomarkers in the prediction of AKI and were also of prognostic value in this setting.

Cited by 379 publications

References 21 publications

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Review article: Acute kidney injury in critical illness

Day-to-day variation of urinary NGAL and rational for creatinine correction

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