title: Acute kidney injury in high-risk cardiac surgery patients: roles of inflammation and coagulation.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a common complication following cardiac surgery. Cardiopulmonary bypass elicits coagulation and inflammation activation and oxidative stress, all involved in AKI but never simultaneously assessed. We aimed to evaluate relations between oxidative stress, inflammatory and coagulation systems activation and postoperative renal function in patients with normal preoperative renal function.
  
  
  METHODS
  Forty-one high-risk patients (EuroSCORE >6 and preoperative haemoglobin <12 g/dl in women and <13 g/dl in men) were prospectively enrolled. Prothrombin fragment 1.2 (coagulation marker), interleukin-6 and interleukin-10 (pro/anti-inflammatory markers) and 8-oxo-2'-deoxyguanosine (oxidative stress marker) were evaluated until postoperative day 5.
  
  
  RESULTS
  Patients were divided into two groups according to estimated glomerular filtration rate reduction observed postoperatively (reduction <25% in 26 patients: NO-AKI group; reduction >25% in 15 patients: AKI group). No differences were found for inflammatory markers. Oxidative stress slightly increased in the AKI group. Twenty-four hours after the operation prothrombin fragment 1.2 levels were significantly higher in the AKI group (506.6 ± 548 vs. 999 ± 704.1 pmol/l; P = 0.018), and they were independently associated with estimated glomerular filtration rate reduction, with an area under the receiving operating characteristic of 0.744.
  
  
  CONCLUSIONS
  Thrombin generation is higher in patients with renal function worsening, and it is an independent risk factor for AKI in patients with anaemia, possibly leading to microcirculation impairment and tubular cells damage.
authors.affiliation: aDivision of Cardiac Surgery, Department of Emergency and Organs Transplant, University of Bari 'Aldo Moro', Bari bDivision of Cardiac Surgery, 'Vito Fazzi' Hospital, Lecce cDivision of Nephrology, Dialysis and Transplantation, Department of Emergency and Organs Transplant, University of Bari 'Aldo Moro', Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scrascia
authors.forename: Crescenzia
authors.initials: C
authors.lastname: Rotunno
authors.forename: Simona
authors.initials: S
authors.lastname: Simone
authors.forename: Eustacchio
authors.initials: E
authors.lastname: Montemurno
authors.forename: Lillà
authors.initials: L
authors.lastname: Amorese
authors.forename: Micaela
authors.initials: M
authors.lastname: De Palo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Castellano
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Pertosa
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000150:complications; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D018836:Inflammation Mediators / Q000097:blood*; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D018384:Oxidative Stress; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011516:Prothrombin; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D010446:Peptide Fragments; C045879:prothrombin fragment 1.2; D011516:Prothrombin