title: MicroRNA-21 and risk of severe acute kidney injury and poor outcomes after adult cardiac surgery.
abstract: BACKGROUND
  Severe acute kidney injury (AKI) after cardiac surgery is associated with poor clinical outcomes. This study evaluated the potential use of miR-21 as a risk marker for postoperative AKI progression and other poor outcomes.
  
  
  RESULTS
  The study included 120 adult patients undergoing cardiac surgery: 40 non-AKI controls, 39 patients with progressive AKI, and 41 with non-progressive AKI. Urine and plasma levels of miR-21 were assessed by quantitative real-time PCR (RT-qPCR). Associations between miR-21 levels and AKI progression were determined by estimating areas under receiver operating characteristic curves (AUC). We demonstrated that up-regulated urine and plasma levels of miR-21 in patients with AKI were both associated with AKI progression. The AUCs for urine and plasma levels of miR-21 associated with established AKI were 0.68 (95%CI: 0.59-0.78) and 0.80 (95%CI: 0.73-0.88), respectively. Multiple logistic regression analysis, adjusting for clinical variables, indicated that the prognostic predictive power of urine and plasma miR-21 levels for AKI progression were represented by AUCs of 0.81 (95%CI: 0.72-0.91) and 0.83 (95%CI: 0.74-0.92), respectively. Urinary and plasma miR-21 levels also predicted the need for postoperative renal replacement therapy (RRT), development of Acute Kidney Injury Network (AKIN) stage 3 AKI, 30-day in-hospital mortality and prolonged stay in hospital or ICU. Urine miR-21 was a better outcome predictor than plasma miR-21, being associated with higher (1.4- to 2.6-fold) unadjusted odds ratio for progression of AKI and other poor outcomes.
  
  
  CONCLUSIONS
  Urinary and plasma miR-21 are associated with severe AKI and other poor postoperative outcomes of cardiac surgery, indicating their potential use as prognostic markers.
authors.affiliation: State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Du
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Cao
authors.forename: Liang
authors.initials: L
authors.lastname: Zou
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.forename: Jin
authors.initials: J
authors.lastname: Guo
authors.forename: Zujun
authors.initials: Z
authors.lastname: Chen
authors.forename: Shengshou
authors.initials: S
authors.lastname: Hu
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zheng
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality / Q000652:urine; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000601:surgery; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D035683:MicroRNAs / Q000097:blood* / Q000652:urine; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000401:mortality / Q000652:urine; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C524940:MIRN21 microRNA, human; D035683:MicroRNAs; D003404:Creatinine