title: Low levels of urinary liver-type fatty acid-binding protein may indicate a lack of kidney protection during aortic arch surgery requiring hypothermic circulatory arrest.
abstract: OBJECTIVE
  To examine the change in liver-type fatty acid-binding protein (L-FABP) levels in patients undergoing aortic arch surgery and the correlation between L-FABP and postoperative acute kidney injury.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Operating room of a general hospital.
  
  
  METHODS
  36 adult patients.
  
  
  METHODS
  Urine samples were obtained to measure urinary L-FABP at initiation of cardiopulmonary bypass (CPB) and 5 minutes after termination of hypothermic circulatory arrest.
  
  
  RESULTS
  22 (61.1%) patients developed acute kidney injury within a 48-hour period. L-FABP increases more than a thousand-fold were found. In patients who subsequently developed acute kidney injury, significant increases in L-FABP were noted from 2.9 (3.6) ng/mg of creatinine before CPB to 62.1 (995.6) ng/mg of creatinine 5 minutes after termination of circulatory arrest. Values in patients who did not develop acute kidney injury increased from 1.1 (5.7) ng/mg before CPB to 1133.0 (6358.8) ng/mg of creatinine showing a significant mean difference (P = 0.011). The area under the L-FABP receiver operating characteristic curve at 5 minutes after termination of circulatory arrest was 0.758. A cutoff value of 75.13 ng/mg of creatinine yielded both good sensitivity (1.000) and specificity (0.546) for detecting non-acute kidney injury. Patients who developed acute kidney injury after aortic arch surgery demonstrated lower levels of urinary L-FABP.
  
  
  CONCLUSIONS
  Low levels of urinary L-FABP may indicate kidney injury and lack of renal protection.
authors.affiliation: Department of Anesthesia, Kawasaki Saiwai Hospital, 31-27 Omiya Saiwai Kawasaki, Kanagawa 212-0014, Japan. Electronic address: yosuke@mori.name.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mori
authors.affiliation: Department of Anesthesiology, Toho University, School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan.
authors.forename: Nobukazu
authors.initials: N
authors.lastname: Sato
authors.affiliation: Department of Anesthesia, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902 Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Anesthesiology, Toho University, School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Ochiai
mesh_terms: D058186:Acute Kidney Injury / Q000652:urine*; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D015415:Biomarkers; D003404:Creatinine / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000652:urine*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D003404:Creatinine
keywords: Acute kidney injury; Aortic arch surgery; Hypothermic circulatory arrest; L-FABP; Liver-type fatty acid-binding protein; Renal protection