Abstract
Acute kidney injury (AKI) is associated with increased morbidity and mortality and is frequently encountered in cardiovascular surgical intensive care units (CVS-ICU). In this study, we aimed at investigating the utility of cyclophilin A (CypA) for the early detection of postoperative AKI in patients undergoing cardiac surgery. This was a prospective observational study conducted in a CVS-ICU of a tertiary care university hospital. All prospective clinical and laboratory data were evaluated as predictors of AKI. Serum and urine CypA, as well as urine neutrophil gelatinase-associated lipocalin (uNGAL), were examined within 6 h after cardiac surgery. The discriminative power for the prediction of AKI was evaluated using the area under the receiver operator characteristic curve (AUROC). We found that both serum CypA and urine CypA were significantly higher in the AKI group than in the non-AKI group. For discriminating AKI and dialysis-requiring AKI, serum CypA demonstrated acceptable AUROC values (0.689 and 0.738, respectively). The discrimination ability of urine CypA for predicting AKI was modest, but it was acceptable for predicting dialysis-requiring AKI (AUROC = 0.762). uNGAL best predicted the development of AKI, but its sensitivity was not good. A combination of serum CypA and uNGAL enhanced the overall performance for predicting the future development of AKI and dialysis-requiring AKI. Our results suggest that CypA is suitable as a biomarker for the early detection of postoperative AKI in CVS–ICU. However, it has better discriminating ability when combined with uNGAL for predicting AKI in CVS-ICU patients.
Highlights
Acute kidney injury (AKI) is a severe complication after cardiac surgery and significantly affects morbidity and mortality [1,2]
Strategies combining biomarkers with different types of pathophysiological relevance may be beneficial in risk stratification. We found that both serum cyclophilin A (CypA) and normalized urine CypA were elevated in the patients who developed AKI after sample collection
Serum CypA is suitable for the early detection of AKI in patients undergoing cardiac surgery, with a good sensitivity and acceptable discriminative power comparable to those of normalized urine neutrophil gelatinase-associated lipocalin (uNGAL)
Summary
Acute kidney injury (AKI) is a severe complication after cardiac surgery and significantly affects morbidity and mortality [1,2]. Up to 15–40% of patients undergoing cardiac surgery develop AKI, with 1–6% requiring renal replacement therapy (RRT) [1,2,3,4]. The mortality rate in cardiac surgery patients with a severe, RRT-requiring AKI can be as high as 60% [3,4]. Even minor increases in serum creatinine (SCr) levels (that is, 20–25% from preoperative baseline) following cardiac surgery are associated with increased mortality [5,6]. Novel biomarkers that can predict the development and severity of AKI earlier after cardiac surgery are important tools in clinical practice
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