Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery

Abstract

Background Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of two inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery. Methods This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children from 1 month to 18 years old undergoing CPB. Plasma IL-6 and IL-10 were measured preoperatively and postoperatively on days 1 (within 6 hours after surgery) and 3. Results Stage 2/3 AKI, defined by atleast a doubling of baseline serum creatinine or dialysis, was diagnosed in 24 (23%) patients. Preoperative IL-6 was significantly higher in patients with stage 2/3 AKI vs. without stage 2/3 AKI (median (IQR), 2.6 (0.6-4.9) vs. 0.6 (0.6-2.2), p=0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a six-fold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted OR 6.41 (CI: 1.16-35.35)). IL-6 and IL-10 increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 did not significantly differ between patients with vs. without stage 2/3 AKI. Elevated IL-6 on day 3 was associated with longer hospital stay (p=0.0001). Conclusions Preoperative plasma IL-6 is associated with development of stage 2/3 AKI and may be prognostic of resource utilization.

Clinical significance of NGAL and KIM-1 for acute kidney injury in patients with scrub typhus

“…This interaction between microbes and endothelial cells triggers a wide range of inflammatory responses, including the production of several cytokines by endothelial and non-endothelial cells. It was reported that some cytokines, including IL-8, contribute to disease severity in patients with scrub typhus [31], and cytokines such as IL-6 and IL-10 were associated with the development of AKI [32]. In our study, levels of three cytokines, IL-10, TNF, and INF, were higher in the AKI group than the non-AKI group.…”

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…The systemic inflammatory response is often observed following major surgery, with considerable variability observed between individuals, although it is recognized that a more severe response is associated with an increased risk of adverse outcomes including AKI . Unsurprisingly, CVS is often associated with such a response and may activate the inflammatory cascade through several pathways . CVS exposes the patient to a risk profile somewhat different from most other major surgeries.…”

“…[32][33][34] Unsurprisingly, CVS is often associated with such a response and may activate the inflammatory cascade through several pathways. 35,36 CVS exposes the patient to a risk profile somewhat different from most other major surgeries. CPB, cross-clamping of the aorta, high doses of exogenous vasopressors, and high rates of exogenous blood product transfusion, for example, all enhance the risks of AKI, especially when coupled with the risk profile for AKI for most of these patients.…”

Early detection of acute kidney injury after pediatric cardiac surgery

“…This was confirmed in a subsequent study of 47 children, in which serum IL-6 levels at 2 h post-CPB moderately predicted AKI in 19 children, with a lower AUC of 0.68 [102]. However, two subsequent larger studies did not document an association between early IL-6 concentrations and subsequent development of AKI after pediatric CPB [103,104]. Further studies are required to evaluate serum IL-6, a central pro-inflammatory cytokine, as an early biomarker of AKI after pediatric CPB.…”