Urinary Cell-Cycle Arrest Biomarkers as Early Predictors of Acute Kidney Injury After Ventricular Assist Device Implantation or Cardiac Transplantation
| Autor: | Brandi L. Wasek, Joost Felius, Amit Alam, Shelley A. Hall, Susan M. Joseph, Teodoro Bottiglieri, Aayla K. Jamil, Johanna S. van Zyl, Horacio Medel-Martinez, Brian Lima |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment chemistry.chemical_compound Internal medicine medicine Humans Prospective Studies Prospective cohort study Tissue Inhibitor of Metalloproteinase-2 Creatinine business.industry Hazard ratio Acute kidney injury Cell Cycle Checkpoints Acute Kidney Injury medicine.disease Transplantation Anesthesiology and Pain Medicine chemistry Cardiothoracic surgery Ventricular assist device Cardiology Heart Transplantation Heart-Assist Devices Cardiology and Cardiovascular Medicine business Biomarkers Kidney disease |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 36:2303-2312 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2021.10.013 |
| Popis: | Objectives Acute kidney injury (AKI) remains a leading source of morbidity and mortality after cardiothoracic surgery. Insulin-like growth factor-binding protein 7 (IGFBP7), and tissue inhibitor of metalloproteinases-2 (TIMP-2), are novel early-phase renal biomarkers that have been validated as sensitive predictors of AKI. Here the authors studied the efficacy of these biomarkers for predicting AKI after left ventricular assist device (LVAD) implantation and cardiac transplantation. Design/Setting/Participants/Interventions This was a prospective study of 73 patients undergoing LVAD implantation (n = 37) or heart transplant (n = 36) from 2016 to 2017 at the authors’ center. TIMP-2 and IGFBP7 were measured with the NephroCheck Test on urine samples before surgery and one-to-six hours after surgery. NephroCheck scores were assessed as predictors of moderate/severe AKI (Kidney Disease International Global Outcomes 2/3 creatinine criteria) within 48 hours of surgery, and the association with survival to one year was investigated. Measurements and Main Results The LVAD and transplant cohorts overall were similar in demographics and baseline creatinine (p > 0.05), with the exception of having more African-American patients in the LVAD arm (p = 0.003). Eleven (30%) LVAD and 16 (44%) transplant patients developed moderate/severe AKI. Overall, AKI was associated with postsurgery NephroCheck (odds ratio [95% confidence interval] for 0.1 mg/dL increase: 1.36 [1.04-1.79]; p = 0.03), but not with baseline NephroCheck (p = 0.92). When analyzed by cohort, this effect remained for LVAD (1.68 [1.05-2.71]; p = 0.03) but not for transplant (p = 0.15). Receiver operating characteristic analysis showed postoperative NephroCheck to be superior to baseline creatinine in LVAD (p = 0.046). Furthermore, an increase of 0.1 mg/dL in postoperative NephroCheck was associated with a 10% increase in the risk of mortality (adjusted hazard ratio: 1.11 [1.01-1.21]; p = 0.04) independent of age and body mass index. Conclusion Assessment of TIMP-2 and IGFBP7 within six hours after surgery appeared effective at predicting AKI in patients with LVADs. Larger studies are warranted to validate these findings. |
| Databáze: | OpenAIRE |
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