Stress Biomarkers Do Not Correlate with Risk Factors for Kidney Injury Following Cardiac Surgery

Author Department

Cardiology; Medicine; Surgery; Nephrology

Document Type

Article, Peer-reviewed

Publication Date

10-2020

Abstract

Background: Urinary cell cycle arrest biomarkers (UB) insulin-like growth factor-binding protein-7 and tissue inhibitor of metalloproteinases-2, provide early detection of kidney stress and elevations may predict cardiac surgery associated-acute kidney injury (CS-AKI). We sought to determine if known clinical risk factors for CS-AKI correlated with increased UB values.

Methods: UB were measured over a 12-month period the morning after on-pump cardiac surgery. Patients with a preoperative serum creatinine > 2.0 mg/dL or dialysis were excluded. Known clinical AKI risk factors in patients with elevated UB (>0.3 (ng/ml)2/1000) which is known to correlate with kidney stress, were compared to patients with low scores (≤ 0.3 (ng/ml)2/1000) using logistic regression; the analysis was repeated with UB as a continuous variable.

Results: 412 patients met inclusion criteria. Unadjusted results demonstrated a clinically similar CS-AKI risk profile in patients with either elevated or low UB values. The Pearson's correlation between preoperative eGFR and UB was low (r = 0.16). Clinical risk factors for CS-AKI were not associated with elevated UB values in the logistic regression model producing an area under the ROC curve of 0.63. Linear regression analysis also found few associations between CS-AKI clinical risk factors and UB when measured as a continuous variable, (R2) = 0.15.

Conclusions: Traditional CS-AKI clinical risk factors do not differ between patients with normal or elevated UB values. This novel urinary biomarker test may identify patients at increased risk for AKI who otherwise would appear low risk by traditional metrics.

PMID

33137299

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