title: Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery.
abstract: Acute kidney injury (AKI) is a frequent complication of cardiac surgery and increases morbidity and mortality. The identification of reliable biomarkers that allow earlier diagnosis of AKI in the postoperative period may increase the success of therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 1219 adults undergoing cardiac surgery 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 patient outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. After multivariable adjustment, the highest quintiles of urine IL-18 and plasma NGAL associated with 6.8-fold and 5-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine and plasma NGAL levels associated with longer length of hospital stay, longer intensive care unit stay, and higher risk for dialysis or death. The clinical prediction model for AKI had an area under the receiver-operating characteristic curve (AUC) of 0.69. Urine IL-18 and plasma NGAL significantly improved the AUC to 0.76 and 0.75, respectively. Urine IL-18 and plasma NGAL significantly improved risk prediction over the clinical models alone as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In conclusion, urine IL-18, urine NGAL, and plasma NGAL associate with subsequent AKI and poor outcomes among adults undergoing cardiac surgery.
authors.affiliation: Section of Nephrology, Yale University and Veterans Administration Medical Center, 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: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Jay L
authors.initials: JL
authors.lastname: Koyner
authors.forename: Zhu
authors.initials: Z
authors.lastname: Wang
authors.forename: Charles L
authors.initials: CL
authors.lastname: Edelstein
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Uptal D
authors.initials: UD
authors.lastname: Patel
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
authors.forename: Cary S
authors.initials: CS
authors.lastname: Passik
authors.forename: Madhav
authors.initials: M
authors.lastname: Swaminathan
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; 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