title: Perioperative heart-type fatty acid binding protein is associated with acute kidney injury after cardiac surgery.
abstract: Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with worse outcomes. Since heart fatty acid binding protein (H-FABP) is a myocardial protein that detects cardiac injury, we sought to determine whether plasma H-FABP was associated with AKI in the TRIBE-AKI cohort; a multi-center cohort of 1219 patients at high risk for AKI who underwent cardiac surgery. The primary outcomes of interest were any AKI (Acute Kidney Injury Network (AKIN) stage 1 or higher) and severe AKI (AKIN stage 2 or higher). The secondary outcome was long-term mortality after discharge. Patients who developed AKI had higher levels of H-FABP pre- and postoperatively than patients who did not have AKI. In analyses adjusted for known AKI risk factors, first postoperative log(H-FABP) was associated with severe AKI (adjusted odds ratio (OR) 5.39 (95% confidence interval (CI), 2.87-10.11) per unit increase), while preoperative log(H-FABP) was associated with any AKI (2.07 (1.48-2.89)) and mortality (1.67 (1.17-2.37)). These relationships persisted after adjustment for change in serum creatinine (for first postoperative log(H-FABP)) and biomarkers of cardiac and kidney injury, including brain natriuretic peptide, cardiac troponin-I, interleukin-18, liver fatty acid binding protein, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin. Thus, perioperative plasma H-FABP levels may be used for risk stratification of AKI and mortality following cardiac surgery.
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Schaub
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
authors.affiliation: Division of General Internal Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.affiliation: Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Eikelboom
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Kavsak
authors.affiliation: Institute for Clinical Evaluative Sciences Western, London, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.affiliation: Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Colleen
authors.initials: C
authors.lastname: Shortt
authors.affiliation: Division of Cardiac Surgery, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Whitlock
authors.affiliation: Department of Internal Medicine and Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009656:North America; D016017:Odds Ratio; D059035:Perioperative Period; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins
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