Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement

Załęska‐Kocięcka, Marta; Skrobisz, Anna; Wojtkowska, Izabela; Grabowski, Maciej; Dąbrowski, M; Kuśmierski, Krzysztof; Piotrowska, Katarzyna; Imiela, Jacek; Stępińska, Janina

doi:10.1093/icvts/ivx198

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…To date, most studies on tubular damage biomarkers (ie, NGAL) and intrarenal inflammation markers (ie, IL-18) have not yielded promising results 15. Our own data indicate that beta-2 microglobulin reflecting glomerular filtration similar to creatinine and cystatin C can be a player worth attention in this population as its cutoff value at 24 hours after valve replacement reached an AUC of 0.880, outperforming cystatin C 16. In the light of the available data, early diagnosis with new biomarkers occurs to be still challenging.…”

Section: Diagnosis and Epidemiologymentioning

confidence: 83%

<p>Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management</p>

Załęska‐Kocięcka¹,

Dąbrowski²,

Stępińska³

2019

CIA

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Aortic stenosis is the most common cause of valve replacement in Europe and North America with prevalence increasing with age. Transcatheter valve replacement (TAVR) represents an alternative for surgical valve replacement of severely stenotic valves. Despite lower risk of acute kidney injury compared to that associated with surgery, this complication remains prevalent in patients undergoing TAVR. There is a paucity of data confirming the relation of acute kidney injury with high morbidity and mortality, especially when superimposed on chronic kidney disease, which is a frequent comorbidity in the elderly with severe aortic stenosis. As there is no consensus on the prevention of acute kidney injury in patients undergoing TAVR, identification and limitation of risk factors are crucial. In this review, we aim to discuss the key aspects of acute kidney injury diagnosis, risk assessment, and outcomes in TAVR patients, and to point out gaps in current knowledge.

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Section: Diagnosis and Epidemiologymentioning

confidence: 83%

<p>Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management</p>

Załęska‐Kocięcka¹,

Dąbrowski²,

Stępińska³

2019

CIA

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“…B2M is a low molecular weight protein and, as a component of the HLA complex, is an important element of the cell surface. An abnormal level of B2M in blood or urea is associated with multiple diseases, such as some acute and chronic inflammations, liver dysfunctions, some viral infections, acute and chronic kidney disease and hematologic malignancies [15][16][17].…”

Section: Figmentioning

confidence: 99%

‘Evaluation of beta-2-microglobulin and neuron-specific enolase as prognostic factors in patients over 65 years of age with frailty syndrome hospitalized for acute coronary syndrome’

Nowak,

Kowalik,

Stępińska

2024

Coronary Artery Disease

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Background The aim of the study is to assess the value of beta-2-microglobulin (B2M) and neuron-specific enolase (NSE) as prognostic factors in the population of patients over 65 years of age with frailty hospitalized due to acute coronary syndrome (ACS). Methods Patients aged ≥65 years with ACS were included. Assessment of frailty was carried out using the FRAIL scale. The measurement of NSE and B2M was carried out three times during hospitalization: (1) at the time of admission, (2) on the second day of hospitalization, (3) on the seventh day of hospitalization, or the day of discharge if it was before the seventh day. The primary endpoint was all-cause mortality, and the secondary endpoint was unscheduled rehospitalization. Results Of the 127 patients, frailty was identified in 39.3%. Multivariate analysis of variance showed significantly higher levels of NSE (P = 0.012) and B2M (P < 0.001) in patients with frailty compared to the nonfrail group and significant changes in marker levels during hospitalization - decreased NSE (P < 0.001) and increased B2M levels (P < 0.001). Elevated B2M-1 level was an independent marker of the occurrence of frailty [odds ratio (OR), 1.98 (1.09–4.00); P = 0.044], and the optimal cutoff point for the diagnosis of frailty was 2.85 mg/l [area under the curve (AUC), 0.718 (0.632–0.795)] with sensitivity 52% and specificity 84.4% (P < 0.001). Elevated NSE-3 level was associated with all-cause mortality, and each 1 ng/ml increase in NSE-3 increased the risk of death by 1.07-fold [OR, 1.07 (1.03–1.10]). Meanwhile, elevated B2M-3 level was associated with unscheduled rehospitalization, and each 1 mg/l increase in B2M-3 increased the risk of unscheduled rehospitalization by 1.21-fold [OR, 1.21 (1.03–1.42)]. The Harrell’s C-index for all-cause mortality was higher for NSE-3 [0.820 (95% confidence interval {CI}, 0.706–0.934)] compared to frailty assessed by the FRAIL scale [0.715 (95% CI, 0.580–0.850)], which means that additional NSE-3 assessment may improve the prediction of all-cause mortality. However, Uno’s C-Statistic analysis showed that the difference was not statistically significant (Pr>chi-square 0.556). Harrell’s C-index for unscheduled rehospitalization was higher for frailty assessed by the FRAIL scale compared to B2M-3. Conclusion Monitoring NSE and B2M marker levels in patients over 65 years of age with frailty and ACS does not provide additional benefits in terms of prognostic ability compared to tests assessing frailty. B2M, assessed upon hospital admission and monitoring NSE and B2M levels during hospitalization may be considered in the diagnosis of frailty and risk stratification in a group of patients for whom currently available frailty diagnostic tools cannot be used.

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“…Plasma metabolite signature profiling with 5-adenosylhomocysteine and β-2 microglobulin has shown great promise in predicting AKI and subsequent progression to CKD. 121,122 Similarly, urinary biomarkers of tubular injury such as neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase-2, and insulin-like growth factor binding protein-7 have demonstrated promise in predicting AKI after AVR in small studies. [123][124][125] As more consistent data become available on the validity of using biomarkers and metabolomic signatures, these will likely be routinely incorporated into clinical decision-making algorithms for best practices for AKI reduction with AVR.…”

Section: Aki Reduction Strategiesmentioning

confidence: 99%

Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association

Shroff¹,

Bangalore²,

Bhave³

et al. 2021

Circulation

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Aortic stenosis with concomitant chronic kidney disease (CKD) represents a clinical challenge. Aortic stenosis is more prevalent and progresses more rapidly and unpredictably in CKD, and the presence of CKD is associated with worse short-term and long-term outcomes after aortic valve replacement. Because patients with advanced CKD and end-stage kidney disease have been excluded from randomized trials, clinicians need to make complex management decisions in this population that are based on retrospective and observational evidence. This statement summarizes the epidemiological and pathophysiological characteristics of aortic stenosis in the context of CKD, evaluates the nuances and prognostic information provided by noninvasive cardiovascular imaging with echocardiography and advanced imaging techniques, and outlines the special risks in this population. Furthermore, this statement provides a critical review of the existing literature pertaining to clinical outcomes of surgical versus transcatheter aortic valve replacement in this high-risk population to help guide clinical decision making in the choice of aortic valve replacement and specific prosthesis. Finally, this statement provides an approach to the perioperative management of these patients, with special attention to a multidisciplinary heart-kidney collaborative team-based approach.

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Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement

Cited by 11 publications

References 19 publications

<p>Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management</p>

<p>Acute kidney injury after transcatheter aortic valve replacement in the elderly: outcomes and risk management</p>

‘Evaluation of beta-2-microglobulin and neuron-specific enolase as prognostic factors in patients over 65 years of age with frailty syndrome hospitalized for acute coronary syndrome’

Evaluation and Management of Aortic Stenosis in Chronic Kidney Disease: A Scientific Statement From the American Heart Association

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