Preoperative serum ST2 level predicts acute kidney injury after adult cardiac surgery

Lobdell, Kevin W.; Parker, Devin M.; Likosky, Donald S.; Rezaee, Michael E.; Ballmoos, Moritz Wyler von; Alam, Shama S.; Owens, Sherry; Thiessen-Philbrook, Heather; MacKenzie, Todd A.; Brown, Jeremiah R.

doi:10.1016/j.jtcvs.2018.03.149

Cited by 21 publications

(18 citation statements)

References 38 publications

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“…In clinical settings, sST2 level is predominantly used to predict mortality after early acute MI or acutely decompensated heart failure since the sST2 baseline is elevated due to myocardial stretch caused by ventricular volume overload [5,6]. Moreover, in studies of postoperative outcomes after cardiac surgery, elevated sST2 levels were found to be associated with increased mortality and kidney failure [7,8]. However, the patients in these studies primarily had normal ventricular function.…”

Section: Introductionmentioning

confidence: 99%

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery

et al. 2019

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Background and Objectives: The aim of this study was to investigate the prognostic value of soluble ST2 (sST2) in predicting postoperative adverse events in patients with impaired left ventricular (LV) function undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: This study included 80 consecutive patients with stable coronary artery disease (CAD) and impaired LV function (ejection fraction ≤ 45%) undergoing on-pump coronary artery bypass graft surgery. The patients were divided into the “high” or “low” group according to their ST2 levels (≥35 or <35 ng/mL). Results: Postoperative adverse events were more common in patients with high sST2 levels than in patients with low sST2 levels (100% vs 26%, p < 0.0001). Multivariate analysis showed that sST2 level was an independent predictor of the presence of postoperative adverse events (OR: 1.117 (95% CI: 1.016–1.228), p = 0.022). The receiver operating characteristic curve (ROC) analysis of sST2 revealed an area under the curve (AUC) of 0.812 (95% CI: 0.710–0.913, p < 0.001) in predicting postoperative adverse events. An sST2 level of 26.50 ng/ml was identified as the optimal cut-off value, with a sensitivity and specificity of 74.1% and 75.3%, respectively. Conclusion: Higher sST2 levels were associated with adverse outcomes after CABG in patients with impaired LV and stable CAD.

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Section: Introductionmentioning

confidence: 99%

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery

et al. 2019

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“…Very recently, Lobdell et al [23] used ST2 to predict AKI before isolated coronary artery bypass graft surgery collecting data from 1,690 patients. The authors found that 35% of the patients developed AKI.…”

Section: Preoperative Biomarkermentioning

confidence: 99%

“…Patients in the highest tercile of ST2 had twice the odds of developing stage 2 or stage 3 AKI compared with stage 1. Lobdell et al's study [23] is the first demonstration of a biomarker as a potential predictor of AKI among patients in a large cardiac surgical cohort.…”

Section: Preoperative Biomarkermentioning

confidence: 99%

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Romagnoli

Ricci

Ronco

2018

Nephron

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Background: Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients’ outcome. Summary: According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrease, that are not renal-specific and have important limitations. However, preoperative risk stratification for postoperative AKI and/or early diagnosis after surgery could be the best way to apply preventive or timely supportive therapeutic measures. Clinical prediction scores, renal functional reserve assessment, and new biomarkers of kidney stress (suppression of tumorigenicity-2, insulin-like growth factor binding protein-7, tissue inhibitor metalloproteinase-2) may help the clinicians to identify patients at risk of AKI and that could benefit from the application of nephroprotective bundles suggested by the KDIGO guidelines. In severe AKI patients with oligoanuria and fluid accumulation, renal replacement therapy is the only supportive measure even if mode and timing remain open to investigation. Key messages: Perioperative AKI is an important and underdiagnosed complication. Identifying patients at high risk of AKI and diagnosing AKI early are major goals. Preventive interventions are mainly based on the KDIGO guidelines and bundles. Furthermore, a personalized multidisciplinary approach should always be considered to minimize the progression of disease and the complications related to kidney damage.

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“…19 Postoperative soluble suppression of tumorgenicity 2 levels has also been showed to be associated with post-operative risk of acute kidney injury in adults after coronary artery bypass graft surgery. 20 N-terminal pro b-type natriuretic peptide is the amino-terminal fragment of B-type natriuretic peptide, which is a neuro-hormone secreted by cardiac myocytes in response to wall stress. 21 In a previous study examining adults undergoing cardiac surgery, higher pre-operative B-type natriuretic peptide levels were associated with an increased risk of post-operative acute kidney injury, 22 and similar studies in children have identified additional biomarkers associated with an increased risk of post-operative acute kidney injury.…”

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confidence: 99%

Post-operative acute kidney injury is associated with a biomarker of acute brain injury after paediatric cardiac surgery

et al. 2020

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Introduction:Children with CHD who undergo cardiopulmonary bypass are at an increased risk of acute kidney injury. This study evaluated the association of end-organ specific injury plasma biomarkers for brain: glial fibrillary acidic protein and heart: Galectin 3, soluble suppression of tumorgenicity 2, and N-terminal pro b-type natriuretic peptide with acute kidney injury in children undergoing cardiopulmonary bypass.Materials and Methods:We enrolled consecutive children undergoing cardiac surgery with cardiopulmonary bypass. Blood samples were collected pre-bypass in the operating room and in the immediate post-operative period. Acute kidney injury was defined as a rise of serum creatinine ≥50% from pre-operative baseline within 7 days after surgery.Results:Overall, 162 children (mean age 4.05 years, sd 5.28 years) were enrolled. Post-operative acute kidney injury developed in 55 (34%) children. Post-operative plasma glial fibrillary acidic protein levels were significantly higher in patients with acute kidney injury (median 0.154 (inter-quartile range 0.059–0.31) ng/ml) compared to those without acute kidney injury (median 0.056 (inter-quartile range 0.001–0.125) ng/ml) (p = 0.043). After adjustment for age, weight, and The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category, each natural log increase in post-operative glial fibrillary acidic protein was significantly associated with a higher risk for subsequent acute kidney injury (adjusted odds ratio glial fibrillary acidic protein 1.25; 95% confidence interval 1.01–1.59). Pre/post-operative levels of galectin 3, soluble suppression of tumorgenicity 2, and N-terminal pro b-type natriuretic peptide did not significantly differ between patients with and without acute kidney injury.Conclusions:Higher plasma glial fibrillary acidic protein levels measured in the immediate post-operative period were independently associated with subsequent acute kidney injury in children after cardiopulmonary bypass. Elevated glial fibrillary acidic protein likely reflects intraoperative brain injury which may occur in the context of acute kidney injury-associated end-organ dysfunction.

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Preoperative serum ST2 level predicts acute kidney injury after adult cardiac surgery

Abstract: Preoperative ST2 levels are associated with postoperative AKI risk and can be used to identify patients at higher risk of developing AKI after cardiac surgery.

Cited by 21 publications

References 38 publications

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures

Post-operative acute kidney injury is associated with a biomarker of acute brain injury after paediatric cardiac surgery

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