title: Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery.
abstract: Acute kidney injury (AKI) occurs commonly after pediatric cardiac surgery and associates with poor outcomes. Biomarkers may help the prediction or early identification of AKI, potentially increasing opportunities for therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 311 children undergoing surgery for congenital cardiac lesions to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. Severe AKI, defined by dialysis or doubling in serum creatinine during hospital stay, occurred in 53 participants at a median of 2 days after surgery. The first postoperative urine IL-18 and urine NGAL levels strongly associated with severe AKI. After multivariable adjustment, the highest quintiles of urine IL-18 and urine NGAL associated with 6.9- and 4.1-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine NGAL levels associated with longer hospital stay, longer intensive care unit stay, and duration of mechanical ventilation. The accuracy of urine IL-18 and urine NGAL for diagnosis of severe AKI was moderate, with areas under the curve of 0.72 and 0.71, respectively. The addition of these urine biomarkers improved risk prediction over clinical models alone as measured by net reclassification improvement and integrated discrimination improvement. In conclusion, urine IL-18 and urine NGAL, but not plasma NGAL, associate with subsequent AKI and poor outcomes among children undergoing cardiac surgery.
authors.affiliation: Section of Nephrology, Yale University and VAMC, 950 Campbell Avenue, Mail Code 151B, West Haven, CT 06516, USA. chirag.parikh@yale.edu
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
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: Richard W
authors.initials: RW
authors.lastname: Kim
authors.forename: Jay L
authors.initials: JL
authors.lastname: Koyner
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Charles L
authors.initials: CL
authors.lastname: Edelstein
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D020382:Interleukin-18 / Q000652:urine*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine*; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000652:urine*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine*
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins