Early postoperative serum cystatin C predicts severe acute kidney injury following cardiac surgery: a post-hoc analysis of a randomized controlled trial

Journal of Cardiothoracic Surgery

Anton Moritz¹  Andres Beiras-Fernandez¹  Ulrich A Stock¹  Christian Reyher²  Juliane Dietz¹  Arndt-Holger Kiessling¹ 

[1] Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, Frankfurt am Main 60590, Germany;Department of Anaesthesiology and Intensive Care, Johann Wolfgang Goethe University, Frankfurtam Main, Germany

关键词: Acute kidney injury;    Cardiopulmonary bypass;    Cardiac surgery;    Cystatin C;   

Others  :  812018
DOI  :  10.1186/1749-8090-9-10

 received in 2013-08-12, accepted in 2013-12-23,  发布年份 2014

【 摘 要 】

Objective

Acute kidney injury (AKI) after cardiac surgery procedures is associated with poor patient outcomes. Cystatin C as a marker for renal failure has been shown to be of prognostic value; however, a wide range of its predictive accuracy has been reported. The aim of the study was to evaluate whether the measurement of pre- and postoperative serum cystatin C improves the prediction of AKI.

Methods

In a single-centre, prospective study of 70 patients (74 ± 9ys; range 47-85ys; 77% male), cystatin C was measured six times: (T1 = preoperative, T2 = start cardiopulmonary bypass (CPB), T3 = 20 min after CPB, T4 = end of operation; T5 = 24 h postoperatively; T6 = 7d postoperatively). Predictive property, in terms of the need for renal replacement therapy (RRT), was analysed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC).

Results

With respect to RRT (n = 8), serum cystatin C was significantly higher at the end of the operation (T4), 24 h postoperatively at T5 and at T6. The AUCs for preoperative T1 and intraoperative T2/3 cystatin C were <0.7 (95% CI, 0.47-0.85). The earliest significant predictive AUCs were found at the end of the operation (T4: p = 0.03 95% CI 0.58-0.88 AUC 0.73) and 24 h postoperatively (T5: p = 0.003 95% CI 0.74-0.96 AUC 0.85).

Conclusions

Early postoperative serum cystatin C increase appears to be a moderate biomarker in the prediction of AKI, whereas a preoperative and intraoperative cystatin C increase has only a limited diagnostic and predictive value.

【 授权许可】

   
2014 Kiessling et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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