Abstract
Cardiac surgery-associated acute kidney injury (CSA-AKI) is commonly observed after cardiac surgery and has been shown to be associated with increased morbidity and mortality. This study was conducted using the Kidney Disease Improving Global Outcomes (KDIGO) criteria to analyze potential perioperative biomarkers of CSA-AKI.
Blood was collected from patients intraoperatively upon entry into the pericardium and 4, 12, 24, and 48 hours postoperatively. Repeated measures mixed model ANOVA analysis was conducted to determine which cytokines and/or chemokines were associated with postoperative CSA-AKI. LASSO regression and random forest modeling were used for variable selection and incorporation into a multivariable regression model.
There were no demographic or preoperative differences between patients with CSA-AKI and without CSA-AKI except for preoperative diabetes status, hemoglobin concentration, and CKD status. Additionally, there were no significant differences between groups regarding preoperative medications. Ten of the forty biomarkers were statistically significant (p<0.05) for the between-groups main effect after repeated measures analysis: myoglobin, GDF-15, NGAL, haptoglobin, TNFα, MCP-1, IL-1RA, IL-8, IL-6, CRP. Multivariable stepwise regression showed the earliest independent predictors of post-operative AKI were 4 hr myoglobin (AOR 1.61 95%CI [1.12-3.12], p=0.036), 4hr IL-1RA (AOR 1.001, 95%CI [1.000-1.001], p=0.48) and 4 hr haptoglobin (AOR 1.07, 95%CI [1.03-1.18], p=0.001).
Multiple cytokines were significantly elevated between the CSA-AKI group and CSA-Non-AKI group. Myoglobin, haptoglobin, and IL-1RA are potential blood biomarkers for AKI after cardiac surgery. Further research is needed to investigate the roles of these biomarkers and their associations with CSA-AKI.
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