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. 2017 Oct 5;6(10):e006565.
doi: 10.1161/JAHA.117.006565.

Haptoglobin 2-2 Phenotype Is Associated With Increased Acute Kidney Injury After Elective Cardiac Surgery in Patients With Diabetes Mellitus

Chenzhuo Feng  1   2 , Bhiken I Naik  1 , Wenjun Xin  3 , Jennie Z Ma  3 , David C Scalzo  1 , Swapna Thammishetti  1 , Robert H Thiele  1 , Zhiyi Zuo  1 , Jacob Raphael  4
Affiliations

Haptoglobin 2-2 Phenotype Is Associated With Increased Acute Kidney Injury After Elective Cardiac Surgery in Patients With Diabetes Mellitus

Chenzhuo Feng et al. J Am Heart Assoc. .

Abstract

Background: Recent studies reported an association between the 2-2 phenotype of haptoglobin (Hp 2-2) and increased cardiorenal morbidity in nonsurgical diabetic patients. Our goal was to determine whether the Hp 2-2 phenotype was associated with acute kidney injury (AKI) after elective cardiac surgery in patients with diabetes mellitus.

Methods and results: We prospectively enrolled 99 diabetic patients requiring elective cardiac surgery with cardiopulmonary bypass. Haptoglobin phenotypes were determined by gel electrophoresis. Cell-free hemoglobin, haptoglobin, and total serum bilirubin were quantified as hemolysis markers. The primary outcome was postoperative AKI, as defined by the Acute Kidney Injury Network classification. The incidence of AKI was significantly higher in Hp 2-2 patients compared with patients without this phenotype (non-Hp-2-2; 55.6% versus 27%, P<0.01). The need for renal replacement therapy was also significantly higher in the Hp 2-2 group (5 patients versus 1 patient, P=0.02). Thirty-day mortality (3 versus 0 patients, P=0.04) and 1-year mortality (5 versus 0 patients, P<0.01) were also significantly higher in patients with the Hp 2-2 phenotype. In multivariable analysis, Hp 2-2 was an independent predictor of postoperative AKI (P=0.01; odds ratio: 4.17; 95% confidence interval, 1.35-12.48).

Conclusions: Hp 2-2 phenotype is an independent predictor of postoperative AKI and is associated with decreased short and long-term survival after cardiac surgery in patients with diabetes mellitus.

Keywords: acute kidney injury; diabetes mellitus; haptoglobin; surgery.

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Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) trial flow diagram. Hp indicates haptoglobin.
Figure 2
Figure 2
Plasma cell‐free hemoglobin concentrations over time (A), haptoglobin concentrations over time (B), and total serum bilirubin over time (C) in patients with Hp 2‐2 phenotype vs patients with non–Hp 2‐2 phenotype. *P<0.05 compared with baseline level. **P<0.01 compared with baseline level. Data are presented as mean±SD. CPB indicates cardiopulmonary bypass; ICU, intensive care unit; Hp, haptoglobin; POD, postoperative day.
Figure 3
Figure 3
Serum creatinine concentrations over time in patients with Hp 2‐2 phenotype vs patients with non–Hp 2‐2 phenotype. *P<0.05 compared with baseline level. **P<0.01 compared with baseline level. Data are presented as mean±SD. ICU indicates intensive care unit; Hp, haptoglobin; POD, postoperative day.
Figure 4
Figure 4
Receiver operator characteristic curves presenting the predictive power for postoperative AKI of the 3 statistical models: (1) clinical risk factors only (non–Hp 2‐2); (2) clinical risk factors and Hp 2‐2 phenotype (risk factors and Hp 2‐2); and (3) clinical risk factors, Hp 2‐2 phenotype, and the interaction with the Society of Thoracic Surgeons risk score (complete model). AKI indicates acute kidney injury; Hp, haptoglobin.
Figure 5
Figure 5
Kaplan–Meier estimates of mortality over time in patients with Hp 2‐2 phenotype vs patients with non–Hp 2‐2 phenotype. Hp indicates haptoglobin.
See this image and copyright information in PMC

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