title: Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery.
abstract: OBJECTIVE
  Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury.
  
  
  METHODS
  We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery. Severe acute kidney injury, defined according to Kidney Disease: Improving Global Outcomes stage 2 or 3, doubling of serum creatinine from the preoperative value, or need for dialysis during hospitalization, was the main outcome. Analyses were adjusted for clinical variables and "renal angina index" components (early decrease in estimated creatinine clearance from baseline and increase in percent of intensive care unit fluid overload on the first postoperative day).
  
  
  RESULTS
  Plasma syndecan-1 levels measured early in the postoperative period were independently associated with severe acute kidney injury. The accuracy of postoperative syndecan-1 for the diagnosis of severe acute kidney injury was moderate (area under the curve receiver operating characteristic, 0.77; 95% confidence interval, 0.68-0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (P = .004) and improved risk prediction, as measured by net reclassification improvement and integrated discrimination improvement. Postoperative sundecan-1 levels also were independently associated with longer length of intensive care unit and hospital stay.
  
  
  CONCLUSIONS
  Postoperative plasma syndecan-1 is associated with subsequent severe acute kidney injury and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for acute kidney injury after cardiac surgery.
authors.affiliation: Hospital do Coração de Messejana, Fortaleza, Ceara, Brazil; Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil.
authors.forename: Candice Torres
authors.initials: CT
authors.lastname: de Melo Bezerra Cavalcante
authors.affiliation: Hospital do Coração de Messejana, Fortaleza, Ceara, Brazil.
authors.forename: Klébia Magalhães
authors.initials: KM
authors.lastname: Castelo Branco
authors.affiliation: Hospital do Coração de Messejana, Fortaleza, Ceara, Brazil.
authors.forename: Valdester Cavalcante
authors.initials: VC
authors.lastname: Pinto Júnior
authors.affiliation: Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil.
authors.forename: Gdayllon Cavalcante
authors.initials: GC
authors.lastname: Meneses
authors.affiliation: Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil.
authors.forename: Fernanda Macedo
authors.initials: FM
authors.lastname: de Oliveira Neves
authors.affiliation: Hospital do Coração de Messejana, Fortaleza, Ceara, Brazil.
authors.forename: Nayana Maria Gomes
authors.initials: NM
authors.lastname: de Souza
authors.affiliation: Hospital do Coração de Messejana, Fortaleza, Ceara, Brazil.
authors.forename: Kiarelle Lourenço
authors.initials: KL
authors.lastname: Penaforte
authors.affiliation: Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Ceara, Fortaleza, Ceara, Brazil.
authors.forename: Alice Maria Costa
authors.initials: AM
authors.lastname: Martins
authors.affiliation: Medical Sciences Postgraduate Program, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Ceara, Brazil; Universidade de Fortaleza-UNIFOR, Fortaleza, Ceara, Brazil; Instituto José Frota, Fortaleza, Ceará, Brazil. Electronic address: alexandreliborio@yahoo.com.br.
authors.forename: Alexandre Braga
authors.initials: AB
authors.lastname: Libório
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001938:Brazil / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D053668:Syndecan-1 / Q000097:blood*
chemical_list: D015415:Biomarkers; D053668:Syndecan-1; D003404:Creatinine
keywords: acute kidney injury; cardiac surgery; syndecan-1