title: Fluid balance and conventional and novel biomarkers of acute kidney injury in cardiovascular surgery.
abstract: OBJECTIVE
  Fluid balance (FB) is an emerging predictor of acute kidney injury (AKI). We investigated the comparative utility of FB with conventional and novel biomarkers to predict AKI in cardiovascular surgery patients.
  
  
  METHODS
  Data collected in a prospective, observational study designed to investigate the relationship between FB and AKI in an academic medical center were utilized for analyses. FB, routine clinical parameters, conventional and novel biomarkers in 100 consecutive cardiovascular surgery patients was analyzed.
  
  
  RESULTS
  Each variable studied was divided into quartiles and the lowest quartile served as the referent quartile. The adjusted OR for AKI for the highest vs. lowest quartile of FB was 4.98 (CI95%1.38-24.10, P=0.046), serum creatinine (SCr) 11.54 (CI95% 1.37-97.18, P=0.024), urine NGAL 2.76 (CI95% 0.48-15.93, P=0.255) and IL-18 2.31 (CI95% 0.41-13.16, P=0.346, and serum MCP-1 4.93 (CI95% 0.81-30.09, P=0.084) and TNF-alpha 15.59 (CI95% 1.19-204.19, P=0.036). Comparison of ROC curves demonstrated that the diagnostic performance of FB and SCr to predict AKI were comparable, as were FB with urine NGAL and IL-18 and serum MCP-1 and TNF-alpha.. While there was a graded relationship with the risk for AKI according to quartiles for FB, SCr and serum TNF-alpha, the remaining biomarkers including urine NGAL were not independent predictors of AKI.
  
  
  CONCLUSIONS
  At 24 hours postoperatively, the performance of FB to predict AKI was comparable to that of preoperative conventional and postoperative 24-hour novel biomarkers.
authors.affiliation: Division of Nephrology Hypertension and Transplantation, University of Florida, Gainesville, FL 32610-0224, USA.
authors.forename: G
authors.initials: G
authors.lastname: Kambhampati
authors.forename: N I
authors.initials: NI
authors.lastname: Ejaz
authors.forename: A
authors.initials: A
authors.lastname: Asmar
authors.forename: R K
authors.initials: RK
authors.lastname: Aiyer
authors.forename: R
authors.initials: R
authors.lastname: Aiyer
authors.forename: A A
authors.initials: AA
authors.lastname: Arif
authors.forename: N
authors.initials: N
authors.lastname: Pourafshar
authors.forename: V R
authors.initials: VR
authors.lastname: Yalamanchili
authors.forename: A Ahsan
authors.initials: AA
authors.lastname: Ejaz
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D018932:Chemokine CCL2 / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005431:Florida; D005919:Glomerular Filtration Rate; D006801:Humans; D020382:Interleukin-18 / Q000652:urine; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000652:urine; D012372:ROC Curve; D012307:Risk Factors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014882:Water-Electrolyte Balance
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D020382:Interleukin-18; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D014409:Tumor Necrosis Factor-alpha; D003404:Creatinine