Abstract
Degradation of endothelial glycocalyx (EG) is associated with inflammation and endothelial dysfunction, which may contribute to the development of acute kidney injury (AKI). We investigated the association between a marker of EG degradation and AKI after valvular heart surgery. Serum syndecan-1 concentrations were measured at induction of anesthesia and discontinuation of cardiopulmonary bypass in 250 patients. Severe AKI was defined as Kidney Disease: Improving Global Outcomes Criteria Stage 2 or 3. Severe AKI occurred in 13 patients (5%). Receiver operating characteristic analysis of preoperative syndecan-1 to predict severe AKI showed area under curve of 0.714 (95% confidence interval (CI), 0.575–0.853; p = 0.009). The optimal cut-off value was 90 ng/mL, with a sensitivity of 61.5% and specificity of 78.5%. In multivariable analysis, both preoperative syndecan-1 ≥ 90 ng/mL and Cleveland Clinic Foundation score independently predicted severe AKI. Severe tricuspid regurgitation was more frequent (42.4% vs. 17.8%, p < 0.001), and baseline right ventricular systolic pressure (41 (33–51) mmHg vs. 33 (27–43) mmHg, p = 0.001) and TNF-α (1.85 (1.37–2.43) pg/mL vs. 1.45 (1.14–1.92) pg/mL, p <0.001) were higher in patients with high preoperative syndecan-1. Patients with high preoperative syndecan-1 had longer hospital stay (16 (12–24) days vs. 13 (11–17) days, p = 0.001). In conclusion, a high preoperative syndecan-1 concentration greater than 90 ng/mL was able to predict severe AKI after valvular heart surgery and was associated with prolonged hospitalization.
Highlights
Acute kidney injury (AKI) is a common complication after cardiac surgery, with an incidence of 5–42% depending on the definition of AKI, extent of the procedure, and patients’ characteristics [1]
The conditions that induce endothelial glycocalyx (EG) degradation and its pathophysiological consequences are closely related to endothelial dysfunction in AKI
We found that elevated preoperative serum creatinine was more frequent in patients with high preoperative syndecan-1 with a borderline statistical significance
Summary
Acute kidney injury (AKI) is a common complication after cardiac surgery, with an incidence of 5–42% depending on the definition of AKI, extent of the procedure, and patients’ characteristics [1]. AKI after cardiac surgery, including a modest elevation in serum creatinine, is independently associated with increased mortality and morbidity [2]. The prognosis of severe AKI is even worse, as mortality increases sharply with more advanced stages of AKI [3]. AKI severity is associated with incremental risk of progression to chronic kidney disease [4]. As there are no proven remedies to treat AKI, strategies to prevent it and alleviate its severity are crucial. Preoperative risk stratification and early detection of injury may aid in the early implementation of such strategies and optimization of patient care
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