Abstract
Acute kidney injury (AKI) is a relevant complication following thoracoabdominal aortic aneurysm repair (TAAA). Biomarkers, such as secretory leucocyte peptidase inhibitor (SLPI), may enable a more accurate diagnosis. In this study, we tested if SLPI measured in serum is an appropriate biomarker of AKI after TAAA repair. In a prospective observational single-center study including 33 patients (51.5% women, mean age 63.0 ± 16.2 years) undergoing open and endovascular aortic aneurysm repair in 2017, SLPI was measured peri-operatively (until 72 h after surgery). After surgery, the postoperative complications AKI, as defined according to the KDIGO diagnostic criteria, sepsis, death, MACE (major cardiovascular events) and, pneumonia were assessed. In a subgroup analysis, patients with preexisting kidney disease were excluded. Of 33 patients, 51.5% (n = 17) of patients developed AKI. Twelve hours after admission to the intensive care unit (ICU), SLPI serum levels were significantly increased in patients who developed AKI. Multivariable logistic regression revealed a significant association between SLPI 12 hours after admission to ICU and AKI (P = 0.0181, OR = 1.055, 95% CI = 1.009–1.103). The sensitivity of SLPI for AKI prediction was 76.47% (95% CI = 50.1–93.2) and the specificity was 87.5% (95% CI = 61.7–98.4) with an AUC = 0.838 (95% CI = 0.7–0.976) for an optimal cut-off 70.03 ng/ml 12 hours after surgery. In patients without pre-existing impaired renal function, an improved diagnostic quality of SLPI for AKI was observed (Sensitivities of 45.45–91.67%, Specificities of 77.7–100%, AUC = 0.716–0.932). There was no association between perioperative SLPI and the incidence of sepsis, death, MACE (major cardiovascular events), pneumonia. This study suggests that SLPI might be a post-operative biomarker of AKI after TAAA repair, with a superior diagnostic accuracy for patients without preexisting impaired renal function.
Highlights
Acute kidney injury (AKI) is a relevant complication following thoracoabdominal aortic aneurysm repair (TAAA)
All patients with AKI fulfilled the diagnostic criteria of a rise in serum creatinine, but only six patients showed a significantly reduced urine output (KDIGO 1: N = 1, KDIGO 2: N = 1, KDIGO 3: N = 4)
The presented results highlight secretory leucocyte peptidase inhibitor (SLPI) as a promising, new biomarker for the detection of postoperative acute kidney after open and endovascular TAAA repair within 72 hours, which may enable the early initiation of organ-protective therapy and reduce the incidence and sequela of AKI and other postoperative complications
Summary
Acute kidney injury (AKI) is a relevant complication following thoracoabdominal aortic aneurysm repair (TAAA). Biomarkers, such as secretory leucocyte peptidase inhibitor (SLPI), may enable a more accurate diagnosis. This study suggests that SLPI might be a post-operative biomarker of AKI after TAAA repair, with a superior diagnostic accuracy for patients without preexisting impaired renal function. Serum creatinine is an established, yet controversial biomarker due to its delayed increase and low sensitivity for the detection of an impaired kidney function[4,5,6] In this context, the necessity of clinically available early and reliable biomarkers of AKI becomes evident. The performance of SLPI as a biomarker of AKI in the setting of TAAA repair has not yet been investigated
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