Serum Interleukin-6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study

Liu, Kathleen D.; Altmann, Christopher; Smits, Gerard; Krawczeski, Catherine D.; Edelstein, Charles L.; Devarajan, Prasad; Faubel, Sarah

doi:10.1186/cc7940

Cited by 190 publications

(185 citation statements)

References 38 publications

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“…Proinflammatory cytokines such as IL-6, IL-8 and TNF-α are increased in patients with AKI, 16 and increased levels of IL-6 and IL-8 predicted prolonged mechanical ventilation in patients with AKI. 15 The inflammatory nature of AKI and the resultant effect on the lungs is highlighted by studies in animal models demonstrating that inflammatory genes are up-regulated in the kidney and lung 32 and that anti-inflammatory treatment with IL-6 inhibition, 33 α-MSH 34 or a p38 MAP kinase inhibitor 35 protect against lung injury in animal models of AKI. Because ESRD is generally regarded as an immune-deficient state, 21 it is possible that the proinflammatory cytokine production may be dampened in patients with ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…For example, increased proinflammatory cytokines associated with AKI may contribute to extra-renal organ dysfunction such as acute lung injury (ALI). [13][14][15][16] Furthermore, recent attention has been given to the role of fluid overload as a factor associated with increased mortality in patients with AKI. [17][18][19] Many of the factors associated with increased mortality in patients with AKI are likely to be absent in patients with end-stage renal disease (ESRD).…”

Section: Introductionmentioning

confidence: 99%

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In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

et al. 2011

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Background/aims: To compare outcomes of critically ill patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) versus those with pre-existing end-stage renal disease (ESRD) requiring CRRT to identify factors that contribute to the increased mortality seen in AKI patients. Methods: Retrospective cohort of 257 intensive care unit (ICU) patients who received CRRT. AKI is defined as requiring CRRT with an admission serum creatinine ≤1 mg/dL; ESRD is defined as chronic dialysis dependence. Primary outcome was hospital mortality. Multivariate logistic regression was performed to determine the impact of APACHE II score, intubation, vasopressors, infection, diabetes, hypertension, gender, and race on mortality. Results: Of 257 patients requiring CRRT, 28 had ESRD and 108 had AKI. Hospital mortality was higher in patients with AKI versus ESRD (69% vs. 39%, p = 0.0032). Severity of illness using APACHE II was similar in AKI and ESRD. Patients with AKI were more likely to require mechanical ventilation (89% vs. 57%, p = 0.0003). After multivariate analysis, the requirement for mechanical ventilation was the single factor associated with increased hospital mortality [odds ratio (OR): 3.1]. Conclusions: In ICU patients requiring CRRT, patients with AKI have a higher mortality than patients with ESRD due to an increased need for mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

et al. 2011

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“…21 This study is one of the first large-scale validations of these two inflammatory cytokines from the early human studies in the setting of cardiac surgery, [22][23][24][25] and it elucidates the state and contributions of inflammation via the cytokine response and balance of pro-and anti-inflammatory forces in AKI.…”

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confidence: 99%

Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery

Zhang

Garg

Coca

et al. 2015

Journal of the American Society of Nephrology

166

119

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Inflammation has an integral role in the pathophysiology of AKI. We investigated the associations of two biomarkers of inflammation, plasma IL-6 and IL-10, with AKI and mortality in adults undergoing cardiac surgery. Patients were enrolled at six academic centers (n=960). AKI was defined as a $50% or $0.3-mg/dl increase in serum creatinine from baseline. Pre-and postoperative IL-6 and IL-10 concentrations were categorized into tertiles and evaluated for associations with outcomes of in-hospital AKI or postdischarge all-cause mortality at a median of 3 years after surgery. Preoperative concentrations of IL-6 and IL-10 were not significantly associated with AKI or mortality. Elevated first postoperative IL-6 concentration was significantly associated with higher risk of AKI, and the risk increased in a dose-dependent manner (second tertile adjusted odds ratio [OR], 1.61 [95% confidence interval (95% CI), 1.10 to 2.36]; third tertile adjusted OR, 2.13 [95% CI, 1.45 to 3.13]). First postoperative IL-6 concentration was not associated with risk of mortality; however, the second tertile of peak IL-6 concentration was significantly associated with lower risk of mortality (adjusted hazard ratio, 0.75 [95% CI, 0.57 to 0.99]). Elevated first postoperative IL-10 concentration was significantly associated with higher risk of AKI (adjusted OR, 1.57 [95% CI, 1.04 to 2.38]) and lower risk of mortality (adjusted HR, 0.72 [95% CI, 0.56 to 0.93]). There was a significant interaction between the concentration of neutrophil gelatinase-associated lipocalin, an established AKI biomarker, and the association of IL-10 concentration with mortality (P=0.01). These findings suggest plasma IL-6 and IL-10 may serve as biomarkers for perioperative outcomes. AKI is a common complication of cardiac surgery, leading to increased morbidity and mortality. 1 Current paradigms of diagnosis and treatment are based on serum creatinine and are thus insensitive. These limitations have spurred the search for novel proteins that are involved in the process of kidney injury. 2,3 While AKI is traditionally recognized and diagnosed by renal functional impairment and structural damage, it is also an inflammatory condition. Understanding and measuring the processes of inflammation in AKI may provide unique tools for its assessment and prediction.To this end, we developed an ancillary study to our large, multicenter cohort study of adult patients

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“…AKI is defined when any of the following three criteria are met; an increase in serum creatinine by 50%, an increase in serum creatinine>0.3 mg/dL or oliguria (21). In the study conducted by Liu and colleagues (14) defined AKI was a 50% or greater increase in serum creatinine from baseline within 3 days. Of the 71 pediatric patients undergoing open heart surgery, AKI developed in 20 patients (28%).…”

Section: Discussionmentioning

confidence: 99%

Open Heart Surgery Associated Acute Kidney Injury in Children

Krastiņš

Straume

Auziņš

et al. 2013

Acta Chirurgica Latviensis

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Summary.Introduction. Cardiac surgery with cardiopulmonary bypass (CPB) is commonly perceived as a risk factor for decline in renal function. Hypothermia, hypoxia, hypotension, non-pulsatile blood flow during CPB, use of ACE inhibitors, inotropic and (or) vasoactive support affects kidney and contributes to the acute kidney injury (AKI). Aim of the study. The purpose of this study was to evaluate the incidence, severity and outcome of CPB related AKI in children after open heart surgery. Materials and methods. We conducted prospective, non-randomized observational study at the tertiary care University Children's Hospital Pediatric ICU. We enrolled 30 patients, 12 boys and 18 girls with congenital heart disease (CHD). Their median body weight was 6,8 kg, (IQR 5,2<8,2 kg) and median age 7 months (IQR 5<10 months). SCr was determined and preoperative and postoperative creatinine clearance (ClCr) was estimated using Schwarz formula (eClCr). During surgical repair and till the end of the first 12 postoperative hours urine was collected to measure ClCr, using the difference in urine (UCr) and SCr concentrations (mClCr). Urine output, body temperature, duration of aortic cross clamping and cardiopulmonary bypass was recorded. Results. Median intraoperative urine output was 2,4 ml/kg/h (IQR 1,29<3,15 ml/kg/h). Median CPB time was 147 min., (IQR 116,75<205 min.), median aortic cross-clamping time was 95 min., (IQR 70,5<133 min.), cooling during CPB to 29,75°C. Postoperative SCr increased to 35 μmol/l (IQR 27,5<50,5 μmol/l) vs. preoperative SCr 29 μmol/l (IQR 24<32,9 μmol/l), P<0,0001. GFR declined from preoperative 98,4 ml/min./1,73 m2 (IQR 89,6<123,04) to postoperative 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2), P<0,0001. We find statistically significant difference (P=0,042) in measured 39,88 ml/min./1,73 m2 (IQR 21,96<67,82 ml/min./1,73 m2) versus estimated ClCr (eClCr) 80,98 ml/min./1,73 m2, (IQR 60,73<97,97 ml/min./1,73 m2). Observed prevalence of AKI was 46,6% (14/30 patients met KDIGO criteria for AKI). Conclusions. Open heart surgery in children has severe, but transient effect on expression of renal biomarkers. There was a marked difference between measured and estimated ClCr in our patients. Observed incidence of AKI was 46,6% (14 patients met KDIGO criteria of AKI from 30 of our patients). Before discharge from the hospital both biomarkers returned to normal values.

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Serum Interleukin-6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study

Cited by 190 publications

References 38 publications

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

In Critically Ill Patients Requiring CRRT, AKI Is Associated with Increased Respiratory Failure and Death Versus ESRD

Plasma IL-6 and IL-10 Concentrations Predict AKI and Long-Term Mortality in Adults after Cardiac Surgery

Open Heart Surgery Associated Acute Kidney Injury in Children

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