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Pediatrics. 2015 Apr;135(4):e945-56. doi: 10.1542/peds.2014-2949. Epub 2015 Mar 9.

Cardiac biomarkers and acute kidney injury after cardiac surgery.

Author information

1
School of Medicine, and Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut;
2
Division of Cardiac Surgery, Population Health Research Institute, and.
3
Division of Nephrology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada;
4
Department of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
5
Division of Cardiac Surgery, Population Health Research Institute, and Medicine, and.
6
Division of Nephrology, Department of Medicine, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada;
7
Division of Nephrology, Department of Medicine, and.
8
Departments of Clinical Epidemiology and Biostatistics.
9
Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California; and.
10
Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada;
11
Department of Internal Medicine, Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut chirag.parikh@yale.edu.

Abstract

OBJECTIVES:

To examine the relationship of cardiac biomarkers with postoperative acute kidney injury (AKI) among pediatric patients undergoing cardiac surgery.

METHODS:

Data from TRIBE-AKI, a prospective study of children undergoing cardiac surgery, were used to examine the association of cardiac biomarkers (N-type pro-B-type natriuretic peptide, creatine kinase-MB [CK-MB], heart-type fatty acid binding protein [h-FABP], and troponins I and T) with the development of postoperative AKI. Cardiac biomarkers were collected before and 0 to 6 hours after surgery. AKI was defined as a ≥ 50% or 0.3 mg/dL increase in serum creatinine, within 7 days of surgery.

RESULTS:

Of the 106 patients included in this study, 55 (52%) developed AKI after cardiac surgery. Patients who developed AKI had higher median levels of pre- and postoperative cardiac biomarkers compared with patients without AKI (all P < .01). Preoperatively, higher levels of CK-MB and h-FABP were associated with increased odds of developing AKI (CK-MB: adjusted odds ratio 4.58, 95% confidence interval [CI] 1.56-13.41; h-FABP: adjusted odds ratio 2.76, 95% CI 1.27-6.03). When combined with clinical models, both preoperative CK-MB and h-FABP provided good discrimination (area under the curve 0.77, 95% CI 0.68-0.87, and 0.78, 95% CI 0.68-0.87, respectively) and improved reclassification indices. Cardiac biomarkers collected postoperatively did not significantly improve the prediction of AKI beyond clinical models.

CONCLUSIONS:

Preoperative CK-MB and h-FABP are associated with increased risk of postoperative AKI and provide good discrimination of patients who develop AKI. These biomarkers may be useful for risk stratifying patients undergoing cardiac surgery.

KEYWORDS:

acute kidney injury; biological markers; brain natriuretic peptide; creatine kinase; fatty acid-binding proteins; pediatrics; postoperative complications; thoracic surgery; troponin

PMID:
25755241
PMCID:
PMC4379461
DOI:
10.1542/peds.2014-2949
[Indexed for MEDLINE]
Free PMC Article
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