title: Comparison of Cystatin C and NGAL in Early Diagnosis of Acute Kidney Injury After Heart Transplantation.
abstract: BACKGROUND Acute kidney injury (AKI) is a risk factor for adverse hospital outcomes in recipients of a heart transplantation (HTx). Timely recognition of AKI is crucial for the initiation of proper treatment. We hypothesized that serum or urine biomarkers can predict AKI. MATERIAL AND METHODS In this prospective study we evaluated 117 consecutive patients after HTx. AKI was defined as an increase of the serum creatinine level by ≥50% or a worsening of the renal function requiring renal replacement therapy during the first post-HTx week. We serially sampled serum cystatin C (S-cystatin C) as a marker of glomerular filtration and urinary neutrophil gelatinase-associated lipocalin (U-NGAL) as a marker of tubular damage. RESULTS A cohort of 30 patients (25.6%) fulfilled the criteria of AKI. S-cystatin C allowed the earliest separation between the AKI and non-AKI groups, with a significant difference present as soon as 3 h after surgery and it persisted on days 7, 10, and 30. The increase in S-cystatin C preceded the serum creatinine elevation by 4 days. In a multivariate analysis, S-cystatin C >1.6 mg/L at 3 h after HTx predicted AKI with OR 4.3 (95% CI: 1.6-11.5). U-NGAL was significantly higher at day 3 in the AKI group (p=0.003) and elevated S-cystatin C (≥2.54 mg/L on day 7) could predict 1-year mortality in these HTx recipients. CONCLUSIONS Our study showed that the measurement of S-cystatin C at 3 h after surgery may help to identify patients with high risk for renal complications. A persistent elevation of S-cystatin C also predicts 1-year mortality.
authors.affiliation: Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Lenka
authors.initials: L
authors.lastname: Hošková
authors.affiliation: Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Janka
authors.initials: J
authors.lastname: Franekova
authors.affiliation: Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ivan
authors.initials: I
authors.lastname: Málek
authors.affiliation: Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.affiliation: Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Szárszoi
authors.affiliation: Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Antonín
authors.initials: A
authors.lastname: Jabor
authors.affiliation: Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Marian
authors.initials: M
authors.lastname: Pinďák
authors.affiliation: Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Viklický
authors.affiliation: Heart Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Vojtěch
authors.initials: V
authors.lastname: Melenovský
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000071068:Lipocalin-2 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000961:Antilymphocyte Serum; D015415:Biomarkers; D055316:Cystatin C; D007166:Immunosuppressive Agents; D000071068:Lipocalin-2; D003404:Creatinine; D009173:Mycophenolic Acid; D016559:Tacrolimus