P0340 / #970: TROPONIN THRESHOLD FOR PREDICTING ACUTE KIDNEY INJURY AND MORTALITY IN INFANTS UNDERGOING CARDIAC SURGERY

Abstract

Aims & Objectives: Acute kidney injury (AKI) occurs in up to 50% of children after cardiopulmonary bypass (CPB) and is independently associated with adverse outcomes including longer lengths of stay (LOS), prolonged mechanical ventilation and higher mortality. Cardiac troponin I (cTnI) a specific marker of myocardial damage has been found to be accurate predictor of complications and adverse clinical events after pediatric cardiac surgery. The purpose of this study was to determine a threshold value of cTnI measured immediately after pediatric open-heart surgery to predict AKI and mortality. Methods: Retrospective observational study in which data from 439 consecutive children undergoing cardiac surgery and entering to the intensive care unit (ICU) during a 10-month period were studied. Clinical, surgical y laboratory variables were evaluated. We used ROC curve to determine our postoperative cTnI threshold level and binary logistic regression to predict development of AKI and mortality. Results: 439 electronic medical records were reviewed, of which 130 met selection criteria, 54% men, mean age of 4.45 ± 4.19 years. A cTnI level of 25 ng/ml showed 94% sensibility to predict AKI. cTnI and RACHS-1 categories 3 and 4 were a strong independent predictor of AKI (p 0.001) and mortality (p 0.004). A value greater than our threshold had statistical significance for LOS 14.8±18.87 (p 0.009). Conclusions: In our study a postoperative cTnI level greater than 25ng/ml was a strong and independent biomarker predictor of AKI and mortality. Identifying these patients may allow anticipation of postoperative course and implementation of treatment strategies.