Preoperative plasma growth-differentiation factor-15 for prediction of acute kidney injury in patients undergoing cardiac surgery

Abstract

BackgroundGrowth-differentiation factor-15 (GDF-15) is an emerging humoral marker for risk stratification in cardiovascular disease. Cardiac-surgery-associated acute kidney injury (CSA-AKI), an important complication in patients undergoing cardiac surgery, is associated with poor prognosis. The present secondary analysis of an observational cohort study aimed to determine the role of GDF-15 in predicting CSA-AKI compared with the Cleveland-Clinic Acute Renal Failure (CC-ARF) score and a logistic regression model including variables associated with renal dysfunction.MethodsPreoperative plasma GDF-15 was determined in 1176 consecutive patients undergoing elective cardiac surgery. Patients with chronic kidney disease stage 5 were excluded. AKI was defined according to Kidney-Disease-Improving-Global-Outcomes (KDIGO) - creatinine criteria. The following variables were screened for association with development of postoperative AKI: age, gender, additive Euroscore, serum creatinine, duration of cardiopulmonary bypass, duration of surgery, type of surgery, total circulatory arrest, preoperative hemoglobin, preoperative oxygen-supplemented cerebral oxygen saturation, diabetes mellitus, hemofiltration during ECC, plasma GDF-15, high sensitivity troponin T (hsTNT), and N-terminal prohormone of B-type natriuretic peptide (NTproBNP).ResultsThere were 258 patients (21.9 %) with AKI (AKI stage 1 (AKI-1), n = 175 (14.9 %); AKI-2, n = 6 (0.5 %); AKI-3, n = 77 (6.5 %)). The incidence of AKI-1 and AKI-3 increased significantly from the lowest to the highest tertiles of GDF-15. In logistic regression, preoperative GDF-15, additive Euroscore, age, plasma creatinine, diabetes mellitus, and duration of cardiopulmonary bypass were independently associated with AKI. Inclusion of GDF-15 in a logistic regression model comprising these variables significantly increased the area under the curve (AUC 0.738 without and 0.750 with GDF-15 included) and the net reclassification ability to predict AKI. Comparably, in receiver operating characteristic analysis the predictive capacity of the CC-ARF score (AUC 0.628) was improved by adding GDF-15 (AUC 0.684) but this score also had lower predictability than the logistic regression model. In random forest analyses the predictive capacity of GDF-15 was especially pronounced in patients with normal plasma creatinine.ConclusionThis suggests that preoperative plasma GDF-15 independently predicts postoperative AKI in patients undergoing elective cardiac surgery and is particularly helpful for risk stratification in patients with normal creatinine.Trial registration NCT01166360 on July 20, 2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1482-3) contains supplementary material, which is available to authorized users.

Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study

“…Geoge J et al [3] analyzed 586 patients who undergoing elective aortic hemiarch reconstruction, they also found CPB time (min) (OR = 1.01, 95% CI: 1.00–1.01; P = 0.03) was an independent risk factor of postoperative AKI. Moreover, several other studies [5, 13, 18, 23, 30] had found that CPB time was an independent predictor of postoperative AKI in patients underwent cardiac and vascular surgery which further verified our findings.…”

Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection

“…Actually, pre-operation elevated sCr concentration might also indicate structural kidney damage or hemodynamic derangements in acute aortic dissection patients, which further aggravated the development of postoperation AKI and the requirement of CRRT. Previous reports also showed the CPB time is an independent risk factor for postoperative AKI during routine cardiac surgery [14,15]. Specifically for aortic surgery, Roh GU et al [1] analyzed 98 patients who underwent graft replacement of the thoracic aorta and found that longer CPB time (> 180 minutes; OR, 7.50; P = 0.008) were independent risk factors for postoperative AKI.…”

Growth differentiation factor-15 levels and the risk of contrast induced nephropathy in patients with acute myocardial infarction undergoing percutaneous coronary intervention: A retrospective observation study

“…It is important to identify high-risk subjects in the early stages to prevent CIN. In the previous study, the incidence of postoperative acute kidney injury increased in patients with high level of preoperative plasma GDF-15, indicating that GDF-15 is useful for risk stratification of CIN in patients with normal creatinine[ 19 , 20 ]. Our study further explored the associations between GDF-15 level and CIN in AMI patients underwent PCI.…”