Brain and Muscle Oxygen Saturation Combined with Kidney Injury Biomarkers Predict Cardiac Surgery Related Acute Kidney Injury.

Wiktor Szymanowicz,Wojtek Karolak,Ludmiła Daniłowicz-Szymanowicz,Maciej Michał Kowalik,Romuald Lango

doi:10.3390/diagnostics11091591

Wiktor Szymanowicz, Wojtek Karolak + Show 3 more

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https://doi.org/10.3390/diagnostics11091591

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Abstract

Background: Early identification of patients at risk for cardiac surgery-associated acute kidney injury (CS-AKI) based on novel biomarkers and tissue oxygen saturation might enable intervention to reduce kidney injury. Aims: The study aimed to ascertain whether brain and muscle oxygenation measured by near-infrared spectroscopy (NIRS), in addition to cystatin C and NGAL concentrations, could help with CS-AKI prediction. Methods: This is a single-centre prospective observational study on adult patients undergoing cardiac surgery using cardiopulmonary bypass (CPB). Brain and muscle NIRS were recorded during surgery. Cystatin C was measured on the first postoperative day, while NGAL directly before and 3 h after surgery. Results: CS-AKI was diagnosed in 18 (16%) of 114 patients. NIRS values recorded 20 min after CPB (with cut-off value ≤ 54.5% for muscle and ≤ 62.5% for the brain) were revealed to be the most accurate predictors of CS-AKI. Preoperative NGAL ≥ 91.5 ng/mL, postoperative NGAL ≥ 140.5 ng/mL, and postoperative cystatin C ≥ 1.23 mg/L were identified as independent and significant CS-AKI predictors. Conclusions: Brain and muscle oxygen saturation 20 min after CPB could be considered early parameters possibly related to CS-AKI risk, especially in patients with increased cystatin C and NGAL levels.

Highlights

Cardiac surgery-associated acute kidney injury (CS-AKI) is a well-recognized, but still incompletely understood, clinical problem that significantly impacts short- and long-term outcomes [1,2]
Serum creatinine level and its changes are the parameters that serve as the criteria for CS-AKI diagnosis; it is not an ideal parameter during short-term changes in kidney function because it lags behind the decline and recovery of glomerular filtration rate (GFR) by days [4]
Our study aimed to evaluate if regional cerebral oxygen saturation and somatic oxygen saturation of thenar muscles (SomO2 ), in addition to blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C concentration, could allow for better CS-AKI prediction in adult patients undergoing cardiac surgery with the use of a cardiopulmonary bypass

Summary

Introduction

Cardiac surgery-associated acute kidney injury (CS-AKI) is a well-recognized, but still incompletely understood, clinical problem that significantly impacts short- and long-term outcomes [1,2]. The role of tissue oximetry monitoring by the NIRS technique in adults in various cardiac surgery procedures has been extensively studied, but the results are inconsistent [15,19,24,25]. Our study aimed to evaluate if regional cerebral oxygen saturation (rScO2 ) and somatic oxygen saturation of thenar muscles (SomO2 ), in addition to blood NGAL and cystatin C concentration, could allow for better CS-AKI prediction in adult patients undergoing cardiac surgery with the use of a cardiopulmonary bypass

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