title: Urinary π-glutathione S-transferase Predicts Advanced Acute Kidney Injury Following Cardiovascular Surgery.
abstract: Urinary biomarkers augment the diagnosis of acute kidney injury (AKI), with AKI after cardiovascular surgeries being a prototype of prognosis scenario. Glutathione S-transferases (GST) were evaluated as biomarkers of AKI. Urine samples were collected in 141 cardiovascular surgical patients and analyzed for urinary alpha-(α-) and pi-(π-) GSTs. The outcomes of advanced AKI (KDIGO stage 2, 3) and all-cause in-patient mortality, as composite outcome, were recorded. Areas under the receiver operator characteristic (ROC) curves and multivariate generalized additive model (GAM) were applied to predict outcomes. Thirty-eight (26.9%) patients had AKI, while 12 (8.5%) were with advanced AKI. Urinary π-GST differentiated patients with/without advanced AKI or composite outcome after surgery (p < 0.05 by generalized estimating equation). Urinary π-GST predicted advanced AKI at 3 hrs post-surgery (p = 0.033) and composite outcome (p = 0.009), while the corresponding ROC curve had AUC of 0.784 and 0.783. Using GAM, the cutoff value of 14.7 μg/L for π-GST showed the best performance to predict composite outcome. The addition of π-GST to the SOFA score improved risk stratification (total net reclassification index = 0.47). Thus, urinary π-GST levels predict advanced AKI or hospital mortality after cardiovascular surgery and improve in SOFA outcome assessment specific to AKI.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Kai-Hsiang
authors.initials: KH
authors.lastname: Shu
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Wang
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, New Taipei City, Taiwan.
authors.forename: Che-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan.
authors.forename: Tao-Min
authors.initials: TM
authors.lastname: Huang
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Pei-Chen
authors.initials: PC
authors.lastname: Wu
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chien-Heng
authors.initials: CH
authors.lastname: Lai
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Tseng
authors.affiliation: NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.|Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Pi-Ru
authors.initials: PR
authors.lastname: Tsai
authors.affiliation: EKF Diagnostics, Cardiff, Wales, UK.
authors.forename: Rory
authors.initials: R
authors.lastname: Connolly
authors.affiliation: Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|NSARF group (National Taiwan University Hospital Study Group of ARF), Taipei, Taiwan.
authors.forename: Vin-Cent
authors.initials: VC
authors.lastname: Wu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000652:urine*; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D005260:Female; D051549:Glutathione S-Transferase pi / Q000652:urine*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012372:ROC Curve; D012306:Risk
chemical_list: D015415:Biomarkers; D051549:Glutathione S-Transferase pi