Abstract
BackgroundThe value of cardiac troponin as a risk assessment tool for cardiac disease in the setting of end-stage renal diseases (ESRD) is not equivalent to its value in those with normal renal function. This consideration had not been studied in settings of acute kidney injury (AKI). We aim to explore the diagnostic value of high sensitive troponin T (hsTnT) in the settings of cardiac surgery-induced AKI.MethodsSingle center observational retrospective study. Based on the AKI Network, patients divided into 2 groups, group I without AKI (259 patients) and group II with AKI (100 patients) where serial testing of hsTnT and creatine kinase (CK)-MB were followed in both groups. Patients with (ESRD) were excluded.ResultsThe mean age in our study was 55.1 ± 10.2 years. High association of AKI (27.8%) was found in our patients. Both groups were matched regarding the age, gender, body mass index, the association of diabetes or hypertension, and Euro score. AKI group had significantly higher mortality 5% vs group I 1.1% (p = 0.03). The hsTnt showed a significant sustained rise in the AKI group as compared to the non-AKI group, however CK-MB changes were significant initially but not sustained.The AKI group was more associated with heart failure 17.9% vs 4.9% (p = 0.001); and post-operative atrial fibrillation, 12.4% vs 2.9% (p = 0.005). Lengths of ventilation, stays in ICU and in hospital were significantly higher in the AKI group.ConclusionsUnlike the CK-MB profile, the hsTnT showed significant changes between both groups all over the course denoting possible delayed clearance in patients with AKI.
Highlights
The value of cardiac troponin as a risk assessment tool for cardiac disease in the setting of end-stage renal diseases (ESRD) is not equivalent to its value in those with normal renal function
The ultimate role of cardiac biomarkers in cardiac surgery remains unresolved, but such biomarkers are currently used in international guidelines to monitor and define myocardial infarction
The following data were recorded for all patients: age, sex, existence of diabetes or hypertension, surgery type, length of anesthesia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, use of vasopressors and inotropes, and Euro SCORE
Summary
The value of cardiac troponin as a risk assessment tool for cardiac disease in the setting of end-stage renal diseases (ESRD) is not equivalent to its value in those with normal renal function. This consideration had not been studied in settings of acute kidney injury (AKI). The ideal analytical infrastructure and target proteins should be highly sensitive for early and late diagnosis, highly specific, easy to use, and affordable These proteins should improve patient outcomes and impact therapeutic modalities [1]. The risk assessment of cardiac troponin and other cardiac biomarkers in end-stage renal disease and normal renal function is not equivalent. Clinical decision making based on cardiac biomarkers in patients with renal diseases requires justification in relation to patient management or outcomes [3].
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