title: Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery.
abstract: In this multicenter, prospective study of 288 children (half under 2 years of age) undergoing cardiac surgery, we evaluated whether the measurement of pre- and postoperative serum cystatin C (CysC) improves the prediction of acute kidney injury (AKI) over that obtained by serum creatinine (SCr). Higher preoperative SCr-based estimated glomerular filtration rates predicted higher risk of the postoperative primary outcomes of stage 1 and 2 AKI (adjusted odds ratios (ORs) 1.5 and 1.9, respectively). Preoperative CysC was not associated with AKI. The highest quintile of postoperative (within 6 h) CysC predicted stage 1 and 2 AKI (adjusted ORs of 6 and 17.2, respectively). The highest tertile of percent change in CysC independently predicted AKI, whereas the highest tertile of SCr predicted stage 1 but not stage 2 AKI. Postoperative CysC levels independently predicted longer duration of ventilation and intensive care unit length of stay, whereas the postoperative SCr change only predicted longer intensive care unit stay. Thus, postoperative serum CysC is useful to risk-stratify patients for AKI treatment trials. More research, however, is needed to understand the relation between preoperative renal function and the risk of AKI.
authors.affiliation: Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Zhu
authors.initials: Z
authors.lastname: Wang
authors.forename: Kyaw
authors.initials: K
authors.lastname: Sint
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bennett
authors.forename: Qing
authors.initials: Q
authors.lastname: Ma
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine