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      Investigation of AKI with Early Biomarkers After Cardiac Surgery

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          Abstract

          Objective

          To provide a new interpretation of the effect of intraoperative hemodynamic data on postoperative acute kidney injury (AKI) development and to determine the accuracy of some biomarkers which are thought to be the early markers of renal injury.

          Methods

          One hundred adult patients who were connected to the heart-lung pump during open-heart surgery were included in this study. Hemodynamic data, oxygen delivery, and transfusions were recorded intraoperatively, and the preoperative and 3. postoperative hour cystatin C, interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) parameters were measured for early detection of kidney damage. In the analysis, 95% significance level was used to determine the difference.

          Results

          According to the Kidney Disease Improving Global Outcomes criterion, AKI developed in 24 patients, 18 of whom were stage 1, two were stage 2, and four were stage 3. AKI (+) patients had more transfusions in the intraoperative period and AKI development was a risk factor for postoperative complications. NGAL and IL-18 levels were found to be approximately two-fold in the postoperative period in AKI (+) patients, whereas cystatin C was not sensitive in AKI detection.

          Conclusion

          AKI development increases the risk of postoperative complications. NGAL and IL-18 were successful in detecting AKI in the early postoperative period.

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          Most cited references29

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          Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group

          Rinaldo Bellomo, Claudio Ronco, John A. Kellum … (2004)
          Introduction There is no consensus definition of acute renal failure (ARF) in critically ill patients. More than 30 different definitions have been used in the literature, creating much confusion and making comparisons difficult. Similarly, strong debate exists on the validity and clinical relevance of animal models of ARF; on choices of fluid management and of end-points for trials of new interventions in this field; and on how information technology can be used to assist this process. Accordingly, we sought to review the available evidence, make recommendations and delineate key questions for future studies. Methods We undertook a systematic review of the literature using Medline and PubMed searches. We determined a list of key questions and convened a 2-day consensus conference to develop summary statements via a series of alternating breakout and plenary sessions. In these sessions, we identified supporting evidence and generated recommendations and/or directions for future research. Results We found sufficient consensus on 47 questions to allow the development of recommendations. Importantly, we were able to develop a consensus definition for ARF. In some cases it was also possible to issue useful consensus recommendations for future investigations. We present a summary of the findings. (Full versions of the six workgroups' findings are available on the internet at ) Conclusion Despite limited data, broad areas of consensus exist for the physiological and clinical principles needed to guide the development of consensus recommendations for defining ARF, selection of animal models, methods of monitoring fluid therapy, choice of physiological and clinical end-points for trials, and the possible role of information technology.
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            A clinical score to predict acute renal failure after cardiac surgery.

            Charuhas V. Thakar, Susana Arrigain, Sarah Worley … (2005)
            The risk of mortality associated with acute renal failure (ARF) after open-heart surgery continues to be distressingly high. Accurate prediction of ARF provides an opportunity to develop strategies for early diagnosis and treatment. The aim of this study was to develop a clinical score to predict postoperative ARF by incorporating the effect of all of its major risk factors. A total of 33,217 patients underwent open-heart surgery at the Cleveland Clinic Foundation (1993 to 2002). The primary outcome was ARF that required dialysis. The scoring model was developed in a randomly selected test set (n = 15,838) and was validated on the remaining patients. Its predictive accuracy was compared by area under the receiver operating characteristic curve. The score ranges between 0 and 17 points. The ARF frequency at each score level in the validation set fell within the 95% confidence intervals (CI) of the corresponding frequency in the test set. Four risk categories of increasing severity (scores 0 to 2, 3 to 5, 6 to 8, and 9 to 13) were formed arbitrarily. The frequency of ARF across these categories in the test set ranged between 0.5 and 22.1%. The score was also valid in predicting ARF across all risk categories. The area under the receiver operating characteristic curve for the score in the test set was 0.81 (95% CI 0.78 to 0.83) and was similar to that in the validation set (0.82; 95% CI 0.80 to 0.85; P = 0.39). In conclusion, a score is valid and accurate in predicting ARF after open-heart surgery; along with increasing its clinical utility, the score can help in planning future clinical trials of ARF.
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              Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment

              Ying Wang, Rinaldo Bellomo (2017)
              Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common complication in adult patients undergoing open heart surgery. In this Review, the authors discuss the definition, epidemiology, pathophysiology and risk factors of CSA-AKI. The authors also explore the use of novel biomarkers of AKI and their potential utility in preventing or treating CSA-AKI.
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                Author and article information

                Contributors
                Hüseyin Mutlu: Role: MD
                Emel Gündüz:
                ORCID: http://orcid.org/0000-0002-0306-9770
                Role: MD
                Tülin Aydoğdu Titiz: Role: MD
                İkbal Özen Küçükçetin: Role: MD
                Journal
                Journal ID (nlm-ta): Braz J Cardiovasc Surg
                Journal ID (iso-abbrev): Braz J Cardiovasc Surg
                Journal ID (publisher-id): rbccv
                Title: Brazilian Journal of Cardiovascular Surgery
                Publisher: Sociedade Brasileira de Cirurgia Cardiovascular
                ISSN (Print): 0102-7638
                ISSN (Electronic): 1678-9741
                Publication date (Print and electronic): Sep-Oct 2020
                Publication date (Print): Sep-Oct 2020
                Volume: 35
                Issue: 5
                Pages: 722-731
                Affiliations
                [1 ] Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
                Author notes
                Correspondence Address: Emel Gündüz, https://orcid.org/0000-0002-0306-9770, Anesteziyoloji, Akdeniz Universitesi Tip Fakultesi, Akdeniz Üniversitesi Ablok Ameliyathane 1. Kat Antalya, Antalya, Turkey, Zip Code: 07070. E-mail: dregunduz@ 123456hotmail.com
                Author information
                http://orcid.org/0000-0002-0306-9770
                Article
                DOI: 10.21470/1678-9741-2019-0178
                PMC ID: 7598966
                PubMed ID: 33118738
                SO-VID: b1f2b735-65ac-49b8-85e5-87952f21a685
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 09 May 2019
                Date accepted : 23 October 2019
                Categories
                Subject: Original Article

                Keywords: lipocalin-2,cst3 protein, human,cystatin c,interleukin-18,risk factors,acute kidney injury,cardiac surgical procedures,biomarkers,kidney,postoperative complications
                Data availability:
                Keywords: lipocalin-2, cst3 protein, human, cystatin c, interleukin-18, risk factors, acute kidney injury, cardiac surgical procedures, biomarkers, kidney, postoperative complications

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