Postoperative Biomarkers Predict Acute Kidney Injury and Poor Outcomes after Adult Cardiac Surgery

Abstract

Acute kidney injury (AKI) is a frequent complication of cardiac surgery and increases morbidity and mortality. The identification of reliable biomarkers that allow earlier diagnosis of AKI in the postoperative period may increase the success of therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 1219 adults undergoing cardiac surgery to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse patient outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. After multivariable adjustment, the highest quintiles of urine IL-18 and plasma NGAL associated with 6.8-fold and 5-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine and plasma NGAL levels associated with longer length of hospital stay, longer intensive care unit stay, and higher risk for dialysis or death. The clinical prediction model for AKI had an area under the receiver-operating characteristic curve (AUC) of 0.69. Urine IL-18 and plasma NGAL significantly improved the AUC to 0.76 and 0.75, respectively. Urine IL-18 and plasma NGAL significantly improved risk prediction over the clinical models alone as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In conclusion, urine IL-18, urine NGAL, and plasma NGAL associate with subsequent AKI and poor outcomes among adults undergoing cardiac surgery. (Clinical Trials.gov number, NCT00774137).

Predictive Ability of Novel Cardiac Biomarkers ST2, Galectin‐3, and NT‐ProBNP Before Cardiac Surgery

“…Participants were prospectively enrolled at 6 academic centers in North America from 2007 through 2010 34. For Canadian participants, mortality was determined using the Registered Persons Database.…”

“…These datasets were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences (ICES). Full study details were previously described 34, 35, 36…”

Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

“…Many of these previously published studies are limited in that they are small single-center studies with low severe AKI event rates (10)(11)(12)(13)(14)(15)(16)(17). However, within the last year, data from the first large international, prospective observational study investigating biomarkers after cardiac surgery have been published (18)(19)(20)(21)(22). The Translational Research Investigating Biomarker Endpoints in AKI (TRIBE AKI) study assembled a cohort of 1219 adults undergoing coronary artery bypass grafting and/or valvular surgery cardiac surgery and 311 children undergoing surgery for congenital cardiac lesions.…”

Postępowanie w okresie okołooperacyjnym u chorych z ryzykiem wystąpienia ostrego uszkodzenia nerek, poddawanych operacjom kardiochirurgicznym

“…Do analizy włączono 1219 chorych z 10 niezależnych badań klinicznych, poddanych zabiegom kardiochirurgicznym, u których wykonano seryjne oznaczenia NGAL w surowicy oraz NGAL i IL-18 (interleukin) w moczu. Podwyższone stężenie NGAL w surowicy i moczu wiązało się z pięciokrotnie większym ryzykiem rozwoju CSA-AKI, stanowiło niezależny czynnik ryzyka zgonu wczesnego a także korelowało z dłuższym czasem hospitalizacji i ryzykiem rozwoju przewlekłej choroby nerek [33]. Co ciekawe, nie zaobserwowano różnic w wynikach oznaczenia NGAL w okresie pooperacyjnym pomiędzy osobami poddawanymi zabiegowi pomostowania wieńcowego w krążeniu pozaustrojowym i bez niego [34].…”