Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study.
OBJECTIVE
To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function.


METHODS
Single-center, prospective observational study.


METHODS
Tertiary hospital.


METHODS
One hundred adult cardiac surgical patients.


RESULTS
We measured concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C, and creatinine and urea at baseline, on arrival in the intensive care unit (ICU) and at 24 hours postoperatively. We assessed such biomarkers in relation to the development of AKI (>50% increase in creatinine from baseline) and to a composite end point (need for renal replacement therapy and in-hospital mortality). We defined an area under the receiver operating characteristic curve of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. On arrival in ICU, plasma NGAL and serum cystatin C were of good predictive value, but creatinine and urea were of poor predictive value. After exclusion of patients with preoperative renal impairment (estimated glomerular filtration rate <60 mL/min), the predictive performance for AKI of all renal biomarkers on arrival in ICU remained unchanged except for cystatin C, which was of fair value in such patients. At 24 hours postoperatively, all renal biomarkers were of good predictive value. On arrival in ICU, novel biomarkers were superior to conventional biomarkers (p < 0.05). Plasma NGAL (p = 0.015) and serum cystatin C (p = 0.007) were independent predictors of AKI and of excellent value in the prediction of the composite end point.


CONCLUSIONS
Early postoperative measurement of plasma NGAL was of good value in identifying patients who developed AKI after adult cardiac surgery. Plasma NGAL and serum cystatin C were superior to conventional biomarkers in the prediction of AKI and were also of prognostic value in this setting.
Haase-Fielitz
Anja
A
Department of Intensive Care, Austin Health, Melbourne, Australia.
Bellomo
Rinaldo
R
Devarajan
Prasad
P
Story
David
D
Matalanis
George
G
Dragun
Duska
D
Haase
Michael
M
D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology; D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D055316:Cystatin C / Q000097:blood; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007668:Kidney / Q000293:injuries*; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D014508:Urea / Q000097:blood
D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D014508:Urea; D003404:Creatinine