Serum Cystatin C as an Early Marker of Neutrophil Gelatinase-associated Lipocalin-positive Acute Kidney Injury Resulting from Cardiopulmonary Bypass in Infants with Congenital Heart Disease.
OBJECTIVE
Acute kidney injury (AKI) is a common complication resulting from cardiopulmonary bypass in infants. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive and specific marker of such injury. In this study, we compared the performance of serum cystatin C (Cys C) and serum creatinine (Cr) as early markers of renal dysfunction in infants undergoing cardiac surgery under bypass.


METHODS
The study was designed as a prospective observational study. The study was conducted in the cardiac intensive care unit (ICU) of a tertiary, academic children's hospital in the United States. Infants (age <1 year) undergoing cardiac surgery under cardiopulmonary bypass were included in the study.


METHODS
Acute kidney injury was defined based on postoperative urinary NGAL.


RESULTS
A total of 17 infants were included in the study, and five of them developed AKI. Serum Cys C and Cr levels were measured postoperatively on days 1, 2, and 3, and compared with baseline levels. On postoperative day 2, infants with AKI showed significant change from baseline in serum Cys C levels compared with non-AKI infants (28% vs. -9%, P = .03). The two groups did not show significant differences with respect to rise in serum Cr on any of the 3 postoperative days. Serum Cr on days 1 and 2 showed nonspecific increases in both AKI and non-AKI groups. The area under the receiver operating characteristic curve for day 2 Cys C was 0.87 (95% CI 0.67-1.00) in recognizing NGAL-positive AKI.


CONCLUSIONS
Postoperative serum Cys C appears to be a more specific and sensitive biomarker for NGAL-positive AKI resulting from cardiopulmonary bypass surgery in infants undergoing cardiac surgery.
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Tex, USA.
Carrie
C
Herbert
Department of Pediatrics, University of Michigan Health System, Ann Arbor, Mich, USA.
Mehul
M
Patel
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Tex, USA.
Alan
A
Nugent
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Tex, USA.
V Vivian
VV
Dimas
Department of Cardiothoracic Surgery, Children's Medical Center Dallas, Dallas, Tex, USA.
Kristine J
KJ
Guleserian
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Tex, USA.
Raymond
R
Quigley
Department of Pediatrics, UT Southwestern Medical Center, Dallas, Tex, USA.
Vinai
V
Modem
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine*; D000367:Age Factors; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve; D062606:Tertiary Care Centers; D013781:Texas; D013997:Time Factors
D000209:Acute-Phase Proteins; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine
AKI; Cardiopulmonary Bypass; Creatinine; Cystatin C; Infants; Urine NGAL