title: Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery.
abstract: BACKGROUND
  Children undergoing cardiac surgery may exhibit a pronounced inflammatory response to cardiopulmonary bypass (CPB). Inflammation is recognized as an important pathophysiologic process leading to acute kidney injury (AKI). The aim of this study was to evaluate the association of the inflammatory cytokines interleukin (IL)-6 and IL-10 with AKI and other adverse outcomes in children after CPB surgery.
  
  
  METHODS
  This is a sub-study of the Translational Research Investigating Biomarker Endpoints in AKI (TRIBE-AKI) cohort, including 106 children ranging in age from 1 month to 18 years undergoing CPB. Plasma IL-6 and IL-10 concentrations were measured preoperatively and postoperatively [day 1 (within 6 h after surgery) and day 3].
  
  
  RESULTS
  Stage 2/3 AKI, defined by at least a doubling of the baseline serum creatinine concentration or dialysis, was diagnosed in 24 (23%) patients. The preoperative IL-6 concentration was significantly higher in patients with stage 2/3 AKI [median 2.6 pg/mL, interquartile range (IQR) 2.6 0.6-4.9 pg/mL] than in those without stage 2/3 AKI (median 0.6 pg/mL, IQR 0.6-2.2 pg/mL) (p = 0.03). After adjustment for clinical and demographic variables, the highest preoperative IL-6 tertile was associated with a sixfold increased risk for stage 2/3 AKI compared with the lowest tertile (adjusted odds ratio 6.41, 95 % confidence interval 1.16-35.35). IL-6 and IL-10 levels increased significantly after surgery, peaking postoperatively on day 1. First postoperative IL-6 and IL-10 measurements did not significantly differ between patients with stage 2/3 AKI and those without stage 2/3 AKI. The elevated IL-6 level on day 3 was associated with longer hospital stay (p = 0.0001).
  
  
  CONCLUSIONS
  Preoperative plasma IL-6 concentration is associated with the development of stage 2/3 AKI and may be prognostic of resource utilization.
authors: Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA, jason.greenberg@yale.edu.
authors: Jason H
authors: JH
authors: Greenberg
authors: Richard
authors: R
authors: Whitlock
authors: William R
authors: WR
authors: Zhang
authors: Heather R
authors: HR
authors: Thiessen-Philbrook
authors: Michael
authors: M
authors: Zappitelli
authors: Prasad
authors: P
authors: Devarajan
authors: John
authors: J
authors: Eikelboom
authors: Peter A
authors: PA
authors: Kavsak
authors: P J
authors: PJ
authors: Devereaux
authors: Colleen
authors: C
authors: Shortt
authors: Amit X
authors: AX
authors: Garg
authors: Chirag R
authors: CR
authors: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002170:Canada; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007223:Infant; D016753:Interleukin-10 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D006435:Renal Dialysis / Q000706:statistics & numerical data; D014481:United States
chemical_list: D015415:Biomarkers; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D016753:Interleukin-10; D003404:Creatinine