Utility of Novel Cardiorenal Biomarkers in the Prediction and Early Detection of Congestive Kidney Injury Following Cardiac Surgery

Abstract

Acute Kidney Injury (AKI) in the context of right ventricular failure (RVF) is thought to be largely congestive in nature. This study assessed the utility of biomarkers high sensitivity cardiac troponin T (hs-cTnT), N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), and neutrophil gelatinase-associated lipocalin (NGAL) for prediction and early detection of congestive AKI (c-AKI) following cardiac surgery. This prospective nested case-control study recruited 350 consecutive patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. Cases were patients who developed (1) AKI (2) new or worsening RVF, or (3) c-AKI. Controls were patients free of these complications. Biomarker levels were measured at baseline after anesthesia induction and immediately postoperatively. Patients with c-AKI had increased mean duration of mechanical ventilation and length of stay in hospital and in the intensive care unit (p < 0.01). For prediction of c-AKI, baseline NT-proBNP yielded an area under the curve (AUC) of 0.74 (95% CI, 0.60–0.89). For early detection of c-AKI, postoperative NT-proBNP yielded an AUC of 0.78 (0.66–0.91), postoperative hs-cTnT yielded an AUC of 0.75 (0.58–0.92), and ∆hs-cTnT yielded an AUC of 0.80 (0.64–0.96). The addition of baseline creatinine to ∆hs-cTnT improved the AUC to 0.87 (0.76–0.99), and addition of diabetes improved the AUC to 0.93 (0.88–0.99). Δhs-cTnT alone, or in combination with baseline creatinine or diabetes, detects c-AKI with high accuracy following cardiac surgery.

Acute Kidney Disease After Acute Decompensated Heart Failure

“…Patients’ clinical characteristics, AKI susceptibility factors, 4 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 28 , 29 , 30 and renal nonrecovery factors for congestive heart failure or critical illness population 31 , 32 , 33 , 34 , 35 were identified according to previous studies or availability in our data set. The risk factors extracted included age, sex, underlying disease (i.e., diabetes mellitus, hypertension, CKD, liver cirrhosis, and malignancy), heart function assessment by New York Heart Association functional class, 36 and left ventricular ejection fraction.…”

A standardized definition for right ventricular failure in cardiac surgery patients

“…Right ventricular failure in the perioperative setting is difficult to diagnose and even more challenging to treat. Refractory post‐operative RVF is associated with up to 22–90% likelihood of in‐hospital mortality, 2,9–11 as well as significant morbidity, including prolonged mechanical ventilation, intensive care unit (ICU) length of stay, renal and hepatic failure, and increased need for inotropic and mechanical circulatory support 7,12–14 . Despite its prognostic importance in cardiac surgery patients, no universally accepted definition of RVF exists in this setting 15 .…”

“…Refractory post-operative RVF is associated with up to 22-90% likelihood of in-hospital mortality, 2,[9][10][11] as well as significant morbidity, including prolonged mechanical ventilation, intensive care unit (ICU) length of stay, renal and hepatic failure, and increased need for inotropic and mechanical circulatory support. 7,[12][13][14] Despite its prognostic importance in cardiac surgery patients, no universally accepted definition of RVF exists in this setting. 15 The lack of a standardized definition also prevents the incorporation of RVF in major cardiac surgery mortality risk models.…”

Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy

“…Serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), as an inactive polypeptide of the pre-prohormone brain natriuretic peptide (BNP), is synthesized and released by cardiomyocytes in response to pressure and volume overload (9)(10)(11). Increasing evidence has shown that the NT-proBNP level is associated with AKI after cardiac surgery (12)(13)(14)(15), medical (non-surgical) patients in cardiac intensive care units (16), or unselected critically ill patients (17). Several studies have also validated NT-proBNP as a predictor of mortality in cardiac surgery patients (12,14,18,19).…”