Investigation of AKI with Early Biomarkers After Cardiac Surgery

Abstract Objective: To provide a new interpretation of the effect of intraoperative hemodynamic data on postoperative acute kidney injury (AKI) development and to determine the accuracy of some biomarkers which are thought to be the early markers of renal injury. Methods: One hundred adult patients who were connected to the heart-lung pump during open-heart surgery were included in this study. Hemodynamic data, oxygen delivery, and transfusions were recorded intraoperatively, and the preoperative and 3. postoperative hour cystatin C, interleukin-18 (IL-18), and neutrophil gelatinase-associated lipocalin (NGAL) parameters were measured for early detection of kidney damage. In the analysis, 95% significance level was used to determine the difference. Results: According to the Kidney Disease Improving Global Outcomes criterion, AKI developed in 24 patients, 18 of whom were stage 1, two were stage 2, and four were stage 3. AKI (+) patients had more transfusions in the intraoperative period and AKI development was a risk factor for postoperative complications. NGAL and IL-18 levels were found to be approximately two-fold in the postoperative period in AKI (+) patients, whereas cystatin C was not sensitive in AKI detection. Conclusion: AKI development increases the risk of postoperative complications. NGAL and IL-18 were successful in detecting AKI in the early postoperative period.

摘要
目的：为阐明术中血流动力学数据对术后急性肾损伤（Acute Kidney Injury, AKI）发生的影响提供新的解读，并明确部分被认为是肾损伤早期标志物的生物标志物的诊断准确性。
方法：本研究纳入100例行心脏直视手术且术中需连接心肺转流泵的成年患者。术中记录患者的血流动力学数据、氧输送情况及输血情况，并分别于术前及术后3小时检测胱抑素C、白细胞介素-18（Interleukin-18, IL-18）及中性粒细胞明胶酶相关脂质运载蛋白（Neutrophil Gelatinase-Associated Lipocalin, NGAL）水平，以早期筛查肾损伤。分析过程中采用95%显著性水平检验组间差异。
结果：根据改善全球肾脏病预后组织（Kidney Disease: Improving Global Outcomes, KDIGO）制定的诊断标准，24例患者发生AKI，其中1期18例、2期2例、3期4例。AKI阳性患者术中输血量更高，且AKI发生是术后并发症的危险因素。AKI阳性患者术后NGAL与IL-18水平约升至基线的2倍，而胱抑素C对AKI的检测敏感性不足。
结论：AKI的发生会升高术后并发症风险；NGAL与IL-18可有效检测术后早期AKI。