Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

Zappitelli, Michael; Krawczeski, Catherine D.; Devarajan, Prasad; Wang, Zhu; Sint, Kyaw; Thiessen-Philbrook, Heather; Li, Simon; Bennett, Michael; Ma, Qing; Shlipak, Michael G.; Garg, Amit X.; Parikh, Chirag R.

doi:10.1038/ki.2011.123

Cited by 121 publications

(89 citation statements)

References 24 publications

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“…In TRIBE-AKI, we found that using a simple baseline clinical risk model, including age, gender, RACHS-1 category, preoperative eGFR percentile, CPB time, and study site, predicted postoperative AKI with AUC 0.77 and was improved by adding biomarkers to this model. 36 Similar risk models may help to increase the specificity and positive predictive value of biomarker screening tests. 58 Before the use of these biomarkers can be incorporated into routine clinical practice, however, AKI prevention strategies must be have confounded the relationship between cardiac biomarkers and postoperative AKI.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

et al. 2015

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OBJECTIVES: To examine the relationship of cardiac biomarkers with postoperative acute kidney injury (AKI) among pediatric patients undergoing cardiac surgery.METHODS: Data from TRIBE-AKI, a prospective study of children undergoing cardiac surgery, were used to examine the association of cardiac biomarkers (N-type pro-B-type natriuretic peptide, creatine kinase-MB [CK-MB], heart-type fatty acid binding protein [h-FABP], and troponins I and T) with the development of postoperative AKI. Cardiac biomarkers were collected before and 0 to 6 hours after surgery. AKI was defined as a $50% or 0.3 mg/dL increase in serum creatinine, within 7 days of surgery. RESULTS:Of the 106 patients included in this study, 55 (52%) developed AKI after cardiac surgery. Patients who developed AKI had higher median levels of pre-and postoperative cardiac biomarkers compared with patients without AKI (all P , .01). Preoperatively, higher levels of CK-MB and h-FABP were associated with increased odds of developing AKI (CK-MB: adjusted odds ratio 4.58, 95% confidence interval [CI] 1.56-13.41; h-FABP: adjusted odds ratio 2.76, 95% CI 1.27-6.03). When combined with clinical models, both preoperative CK-MB and h-FABP provided good discrimination (area under the curve 0.77, 95% CI 0.68-0.87, and 0.78, 95% CI 0.68-0.87, respectively) and improved reclassification indices. Cardiac biomarkers collected postoperatively did not significantly improve the prediction of AKI beyond clinical models.CONCLUSIONS: Preoperative CK-MB and h-FABP are associated with increased risk of postoperative AKI and provide good discrimination of patients who develop AKI. These biomarkers may be useful for risk stratifying patients undergoing cardiac surgery.WHAT'S KNOWN ON THIS SUBJECT: Acute kidney injury (AKI) occurs in up to 50% of children after cardiopulmonary bypass and is associated with adverse outcomes. Renal biomarkers have been shown to predict postoperative AKI, but few studies have examined cardiac biomarkers for risk classification.WHAT THIS STUDY ADDS: Preoperative levels of creatine kinase-MB and heart-type fatty acid binding protein are strongly associated with the development of postoperative AKI after pediatric cardiac surgery and can be used to improve preoperative clinical risk prediction.

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Section: Discussionmentioning

confidence: 99%

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

et al. 2015

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“…5,6 In recent years, several studies have shown that novel biomarkers can detect acute tubular injury earlier than serum creatinine in the setting of AKI. [7][8][9][10][11] Despite attempts to select patients at high risk for severe AKI, the majority of patients in these prospective studies do not develop clinical AKI. Additionally, most of those patients who develop AKI experience a milder form of AKI (e.g., AKIN stage 1 or RIFLE R) with transient bumps in serum creatinine and do not progress to more severe AKI stages (AKIN stage 2 or 3 or RIFLE F) or require acute dialysis.…”

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confidence: 99%

Biomarkers Predict Progression of Acute Kidney Injury after Cardiac Surgery

Koyner

Garg

Coca

et al. 2012

Journal of the American Society of Nephrology

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255

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Being able to predict whether AKI will progress could improve monitoring and care, guide patient counseling, and assist with enrollment into trials of AKI treatment. Using samples from the Translational Research Investigating Biomarker Endpoints in AKI study (TRIBE-AKI), we evaluated whether kidney injury biomarkers measured at the time of first clinical diagnosis of early AKI after cardiac surgery can forecast AKI severity. Biomarkers included urinary IL-18, urinary albumin to creatinine ratio (ACR), and urinary and plasma neutrophil gelatinaseassociated lipocalin (NGAL); each measurement was on the day of AKI diagnosis in 380 patients who developed at least AKI Network (AKIN) stage 1 AKI. The primary end point (progression of AKI defined by worsening AKIN stage) occurred in 45 (11.8%) patients. Using multivariable logistic regression, we determined the risk of AKI progression. After adjustment for clinical predictors, compared with biomarker values in the lowest two quintiles, the highest quintiles of three biomarkers remained associated with AKI progression: IL-18 (odds ratio=3.0, 95% confidence interval=1.3-7.3), ACR (odds ratio=3.4, 95% confidence interval=1.3-9.1), and plasma NGAL (odds ratio=7.7, 95% confidence interval=2.6-22.5). Each biomarker improved risk classification compared with the clinical model alone, with plasma NGAL performing the best (category-free net reclassification improvement of 0.69, P,0.0001). In conclusion, biomarkers measured on the day of AKI diagnosis improve risk stratification and identify patients at higher risk for progression of AKI and worse patient outcomes.

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“…The accuracy of urine IL-18 and urine NGAL for diagnosis of severe AKI was moderate, with AUCs of 0.72 and 0.71, respectively. In this pediatric cohort, none of the quintiles of plasma NGAL were independently associated with the development of postoperative severe AKI (19 (22).…”

Section: Postoperative Biomarkersmentioning

confidence: 99%

“…Many of these previously published studies are limited in that they are small single-center studies with low severe AKI event rates (10)(11)(12)(13)(14)(15)(16)(17). However, within the last year, data from the first large international, prospective observational study investigating biomarkers after cardiac surgery have been published (18)(19)(20)(21)(22). The Translational Research Investigating Biomarker Endpoints in AKI (TRIBE AKI) study assembled a cohort of 1219 adults undergoing coronary artery bypass grafting and/or valvular surgery cardiac surgery and 311 children undergoing surgery for congenital cardiac lesions.…”

Section: Aki Associated With Cardiac Surgerymentioning

confidence: 99%

Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

Koyner

Parikh

2013

Clinical Journal of the American Society of Nephrology

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102

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SummaryAKI is a common and serious complication that is associated with several adverse outcomes in hospitalized patients. The past several years have seen a large number of multicenter investigations of biomarkers of AKI in the setting of cardiac surgery and critical illness. This review summarizes these biomarker results to identify applications for clinical use. The Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) study showed that blood and urine biomarkers measured preoperatively, immediately postoperatively, and at the time of the clinical increase in serum creatinine in the setting of cardiac surgery all had the ability to improve patient risk stratification for a variety of important clinical end points. Analyses of biomarkers concentrations from the Acute Respiratory Distress Syndrome Network, EARLY ARF, and other studies of critically ill subjects have similarly shown that biomarkers measured early in the clinical course can forecast the development of AKI and need for renal replacement therapy as well as inpatient mortality. Although biomarkers have informed the diagnosis, prognosis, and treatment of AKI and are inching closer to clinical application, large multicenter interventional clinical trials to prevent AKI using biomarkers should continue to be an active area of clinical investigation.

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Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

Cited by 121 publications

References 24 publications

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Biomarkers Predict Progression of Acute Kidney Injury after Cardiac Surgery

Clinical Utility of Biomarkers of AKI in Cardiac Surgery and Critical Illness

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