Assessment and Prognosis in CSA-AKI Using Novel Kidney Injury Biomarkers: A Prospective Observational Study

Udzik, Jakub; Waszczyk, Aleksandra; Safranow, Krzysztof; Biskupski, Andrzej; Majer, Krzysztof; Kwiatkowski, Sebastian; Kwiatkowska, Ewa

doi:10.3390/biology10090823

Cited by 6 publications

(6 citation statements)

References 55 publications

(60 reference statements)

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“…Indeed, the KDIGO score for the assessment of kidney failure confirmed that most human patients do not present kidney failure in this study, which is consistent with the literature [ 30 , 31 ]. Acute kidney failure or AKI during and after CPB is currently a major research challenge [ 30 , 32 , 33 ] for both biomarker and therapeutic research. AKIs are the consequence of common adverse events, including hemodilution, hemolysis, inflammation [ 34 ], neuro–hormonal changes, and vasopressor use and misuse during CPB in cardiac surgeries.…”

Section: Discussionmentioning

confidence: 99%

A Rat Model of Clinically Relevant Extracorporeal Circulation Develops Early Organ Dysfunctions

Persello

Souab

Dupas

et al. 2023

IJMS

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In clinical practice, extracorporeal circulation (ECC) is associated with coagulopathy and inflammation, eventually leading to organ injuries without preventive systemic pharmacological treatment. Relevant models are needed to reproduce the pathophysiology observed in humans and preclinical tests. Rodent models are less expensive than large models but require adaptations and validated comparisons to clinics. This study aimed to develop a rat ECC model and to establish its clinical relevance. One hour of veno-arterial ECC or a sham procedure were achieved on mechanically ventilated rats after cannulations with a mean arterial pressure objective > 60 mmHg. Five hours post-surgery, the rats’ behavior, plasmatic/blood biomarkers, and hemodynamics were measured. Blood biomarkers and transcriptomic changes were compared in 41 patients undergoing on-pump cardiac surgery. Five hours post-ECC, the rats presented hypotension, hyperlactatemia, and behavioral alterations. The same patterns of marker measurements (Lactate dehydrogenase, Creatinine kinase, ASAT, ALAT, and Troponin T) were observed in both rats and human patients. Transcriptome analyses showed similarity in both humans and rats in the biological processes involved in the ECC response. This new ECC rat model seems to resemble both ECC clinical procedures and the associated pathophysiology, but with early organ injury corresponding to a severe phenotype. Although the mechanisms at stake in the post-ECC pathophysiology of rats or humans need to be described, this new rat model appears to be a relevant and costless preclinical model of human ECC.

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Section: Discussionmentioning

confidence: 99%

A Rat Model of Clinically Relevant Extracorporeal Circulation Develops Early Organ Dysfunctions

Persello

Souab

Dupas

et al. 2023

IJMS

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“…The data used in this study correspond to the Heart Institute, Hospital “das Clínicas”, Faculty of Medicine, University of São Paulo, Brazil, to compare the length of stay of

patients with heart disease undergoing cardiac surgery [ 45 ]. The considered covariates are: age of the patient, type of protocol, race, sex, and type of patient.…”

Section: Application To Biomedical Datamentioning

confidence: 99%

Weibull Regression and Machine Learning Survival Models: Methodology, Comparison, and Application to Biomedical Data Related to Cardiac Surgery

Cavalcante

Ospina

Leiva

et al. 2023

Biology

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In this article, we propose a comparative study between two models that can be used by researchers for the analysis of survival data: (i) the Weibull regression model and (ii) the random survival forest (RSF) model. The models are compared considering the error rate, the performance of the model through the Harrell C-index, and the identification of the relevant variables for survival prediction. A statistical analysis of a data set from the Heart Institute of the University of São Paulo, Brazil, has been carried out. In the study, the length of stay of patients undergoing cardiac surgery, within the operating room, was used as the response variable. The obtained results show that the RSF model has less error rate for the training and testing data sets, at 23.55% and 20.31%, respectively, than the Weibull model, which has an error rate of 23.82%. Regarding the Harrell C-index, we obtain the values 0.76, 0.79, and 0.76, for the RSF and Weibull models, respectively. After the selection procedure, the Weibull model contains variables associated with the type of protocol and type of patient being statistically significant at 5%. The RSF model chooses age, type of patient, and type of protocol as relevant variables for prediction. We employ the randomForestSRC package of the R software to perform our data analysis and computational experiments. The proposal that we present has many applications in biology and medicine, which are discussed in the conclusions of this work.

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“…In the case of fluid excess, hemofiltration should also be targeted to provide an adequate fluid balance in the post-CPB period. Intraoperative hypovolemia should be avoided though, as it has a proven detrimental impact on kidney function [115,116]. A further significant benefit of hemofiltration during the CPB is osmotic load and metabolite removal.…”

Section: Fluid Balance and Osmotic Regulationmentioning

confidence: 99%

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

Udzik,

Pacholewicz,

Biskupski

et al. 2023

JCM

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Introduction: According to different authors, cardiac surgery-associated acute kidney injury (CSA-AKI) incidence can be as high as 20–50%. This complication increases postoperative morbidity and mortality and impairs long-term kidney function in some patients. This review aims to summarize current knowledge regarding alterations to renal physiology during cardiopulmonary bypass (CPB) and to discuss possible nephroprotective strategies for cardiac surgeries. Relevant sections: Systemic and renal circulation, Vasoactive drugs, Fluid balance and Osmotic regulation and Inflammatory response. Conclusions: Considering the available scientific evidence, it is concluded that adequate kidney perfusion and fluid balance are the most critical factors determining postoperative kidney function. By adequate perfusion, one should understand perfusion with proper oxygen delivery and sufficient perfusion pressure. Maintaining the fluid balance is imperative for a normal kidney filtration process, which is essential for preserving the intra- and postoperative kidney function. Future directions: The review of the available literature regarding kidney function during cardiac surgery revealed a need for a more holistic approach to this subject.

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Assessment and Prognosis in CSA-AKI Using Novel Kidney Injury Biomarkers: A Prospective Observational Study

Cited by 6 publications

References 55 publications

A Rat Model of Clinically Relevant Extracorporeal Circulation Develops Early Organ Dysfunctions

A Rat Model of Clinically Relevant Extracorporeal Circulation Develops Early Organ Dysfunctions

Weibull Regression and Machine Learning Survival Models: Methodology, Comparison, and Application to Biomedical Data Related to Cardiac Surgery

Alterations to Kidney Physiology during Cardiopulmonary Bypass—A Narrative Review of the Literature and Practical Remarks

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