Combining Novel Renal Injury Markers with Delta Serum Creatinine Early after Cardiac Surgery and Risk-Stratification for Serious Adverse Outcomes: An Exploratory Analysis

McIlroy, David R.; Farkas, David; Pan, Kun; Pickering, John W.; Lee, H. Thomas

doi:10.1053/j.jvca.2017.12.052

Cited by 14 publications

(8 citation statements)

References 26 publications

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“…A promising recent study examined several renal biomarkers, including kidney injury molecule-1, neutrophil gelatinase-associated lipocalin, and cystatin C, and failed to show that any of them alone were better at predicting the necessity of renal replacement therapy or hospital mortality than changes in creatinine. 101 However, when the biomarkers were combined, along with a measure of change in creatinine, they could predict adverse events with excellent sensitivity and specificity. NephroCheck (Astute Medical, USA) was authorized by the U.S. Food and Drug Administration in 2014 as a point-of-care urinary biomarker assay to evaluate acute kidney injury development.…”

Section: Novel Acute Kidney Injury Biomarkersmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Gumbert

Kork²,

Jackson³

et al. 2020

Anesthesiology

208

138

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Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients.

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Section: Novel Acute Kidney Injury Biomarkersmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Gumbert

Kork²,

Jackson³

et al. 2020

Anesthesiology

208

138

View full text Add to dashboard Cite

show abstract

“…It has been reported that serum chitinase 3-like protein 1 combined with NGAL has a good predictive value for severe AKI (AKI stage≥2) [43]. Additionally, combining urinary NGAL with urinary CysC, KIM-1, chemokine ligand 2, and interleukin- (IL-) 18 enables the early identification of patients with serious adverse outcomes (hospital mortality or renal replacement therapy (RRT)) [44].…”

Section: Renal Tubule-associated Biomarkersmentioning

confidence: 99%

Biomarkers of Acute Kidney Injury after Cardiac Surgery: A Narrative Review

Chen

Yang

2019

BioMed Research International

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Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major and serious complication in patients undergoing cardiac surgery and is independently associated with perioperative mortality and mortality. Therapeutic intervention aiming at reversing kidney dysfunction seems disappointing across multiple settings. Consequently, attention has shifted from treatment to prevention and early detection. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines have unified diagnostic standards mainly based on the serum creatinine (Scr) level or urine output, but neither marker is kidney specific. Efforts have been made to identify novel biomarkers with high sensitivity and specificity. The diagnostic capabilities of neutrophil gelatinase-associated lipocalin (NGAL) and G1 cell cycle arrest biomarker as biomarkers have been confirmed in a large number of clinical trials. The utility of biomarkers of cardiac function and inflammation has been validated in clinical studies. Aiming to offer valuable information for further research, we summarize the progress in defining current markers relevant to CSA-AKI in the last three years.

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“…In this respect, the study by McIlroy et al 7 in this issue of the Journal of Cardiothoracic and Vascular Anesthesia potentially adds some new insights. In their secondary analysis of a prospective observational study, the authors evaluated 5 urinary biomarkers in combination with an early increase in serum creatinine (ΔS cr-initial ) for the prediction of a composite of mortality and the need for RRT in patients undergoing cardiac surgery.…”

mentioning

confidence: 97%

“…10 Furthermore, given the limited economic resources, clinicians should restrict the use of potentially expensive test kits to only patients at risk. However, as no clinical risk factors were applied, the findings and conclusion by McIlroy et al 7 in a general population of cardiac surgery patients might not be transferred to patients at risk.…”

mentioning

confidence: 97%