Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest

Kevin Pilarczyk,Mohamed Salem,Katharina Huenges,Assad Haneya,Toni Jacob,Bernd Panholzer,Jochen Cremer

doi:10.3390/jcm11041024

Abstract

(1) Background: Acute kidney injury (AKI) is a common complication following thoracic aortic surgery (TAS), with moderate hypothermic circulatory arrest (MHCA). However, prediction of AKI with classical tools remains uncertain. Therefore, it was the aim of the present study to evaluate the role of new biomarkers in patients after MHCA. (2) Methods: 101 consecutive patients were prospectively enrolled. Measurements of urinary [TIMP-2]*[IGFBP7] and Cystatin C in the blood were performed perioperatively. Primary endpoint was the occurrence of AKI stage 2 or 3 (KDIGO-classification) within 48 h after surgery (AKI group). (3) Results: Mean age of patients was 69.1 ± 10.9 years, 35 patients were female (34%), and 13 patients (13%) met the primary endpoint. Patients in the AKI group had a prolonged ICU-stay (6.9 ± 7.4 days vs. 2.5 ± 3.1 days, p < 0.001) as well as a higher 30-day-mortality (9/28 vs. 1/74, p < 0.001). Preoperative serum creatinine (169.73 ± 148.97 μmol/L vs. 89.74 ± 30.04 μmol/L, p = 0.027) as well as Cystatin C (2.41 ± 1.54 mg/L vs. 1.13 ± 0.35 mg/L, p = 0.029) were higher in these patients. [TIMP-2]*[IGFBP7] increased significantly four hours after surgery (0.6 ± 0.69 mg/L vs. 0.37 ± 0.56 mg/L, p = 0.03) in the AKI group. Preoperative Cystatin C (AUC 0.828, p < 0.001) and serum creatinine (AUC 0.686, p = 0.002) as well as [TIMP-2]*[IGFBP7] 4 h after surgery (AUC 0.724, p = 0.020) were able to predict postoperative AKI. The predictive capacity of Cystatin C was superior to serum creatinine (p = 0.0211) (4) Conclusion: Cystatin C represents a very sensitive and specific biomarker to predict AKI in patients undergoing thoracic surgery with MHCA even before surgery, whereas the predictive capacity of [TIMP-2]*[IGFBP7] is only moderate and inferior to that of serum creatinine.

Highlights

Introduction iationsMore than 30 years ago moderate hypothermic circulatory arrest (MHCA) was introduced for cerebral protection during aortic arch surgery
MHCA has proven to be an effective technique for protecting various organs from ischemic damage as a result of circulatory arrest, the incidence of acute kidney injury (AKI) after thoracic aortic surgery ranges from 18% to 55%
101 patients undergoing thoracic aortic surgery (TAS) with MHCA were included in this study. 27 patients

Summary

Introduction

More than 30 years ago moderate hypothermic circulatory arrest (MHCA) was introduced for cerebral protection during aortic arch surgery. Improved surgical and anesthetic techniques have facilitated increasingly complex aortic reconstructions with decreased morbidity and mortality. MHCA has proven to be an effective technique for protecting various organs from ischemic damage as a result of circulatory arrest, the incidence of acute kidney injury (AKI) after thoracic aortic surgery ranges from 18% to 55%. Being higher than in other aortic procedures [1–5]. Renal dysfunction leads to increased postoperative morbidity and mortality, and patients requiring renal replacement therapy (RRT) have an elevated short-term mortality of up to 64% [1–5]. Risk assessment for AKI is recommended by clinical practice guidelines but remains imprecise mainly due to very limited sensitivity and specificity of early diagnostic tests.

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