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Observational Study
. 2021 Apr 7;22(1):120.
doi: 10.1186/s12882-021-02322-0.

Prognostic value of suPAR and hsCRP on acute kidney injury after cardiac surgery

Sebastian Roed Rasmussen  1 , Rikke Vibeke Nielsen  2 , Rasmus Møgelvang  2   3   4 , Sisse Rye Ostrowski  3   5 , Hanne Berg Ravn  2   3   6
Affiliations
Observational Study

Prognostic value of suPAR and hsCRP on acute kidney injury after cardiac surgery

Sebastian Roed Rasmussen et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury (AKI) represents a serious complication following cardiac surgery. Adverse outcome after cardiac surgery has been observed in the presence of elevated levels of soluble urokinase-type plasminogen activator receptor (suPAR) and high-sensitivity C-Reactive Protein (hsCRP). The aim of study was (i) to investigate the relationship between preoperative elevated levels of suPAR and hsCRP and postoperative AKI in unselected cardiac surgery patients and (ii) to assess whether the concentration of the biomarkers reflected severity of AKI.

Methods: In a retrospective observational study, biobank blood plasma samples (n = 924) from patients admitted for elective on-pump cardiac surgery were analysed for suPAR and hsCRP levels. The relation between suPAR and hsCRP-values and AKI (any stage), defined by the KDIGO (Kidney Disease: Improving Global Outcomes) criteria, was assessed using adjusted logistic regression. Further, the association between biomarkers and severity (KDIGO 1, KDIGO 2-3 and renal replacement therapy (RRT)) was assessed using adjusted logistic regression.

Results: Postoperative AKI (any stage) was observed in 327 patients (35.4 %). A doubling of preoperative suPAR corresponded to an adjusted odds ratio (OR) for postoperative AKI (any stage) of 1.62 (95 % CI 1.26-2.09, p < 0.001). Furthermore, a doubling of suPAR had an adjusted OR of 1.50 (95 % CI 1.16-1.93, p = 0.002), 2.44 (95 % CI 1.56-3.82, p < 0.001) and 1.92 (95 % CI 1.15-3.23, p = 0.002), for KDIGO 1, KDIGO 2-3 and need for RRT, respectively. No significant association was found between elevated levels of hsCRP and any degree of AKI.

Conclusions: Increasing levels of suPAR, but not hsCRP, were associated with development and severity of AKI following on-pump cardiac surgery.

Keywords: Acute kidney injury; Biomarkers; Cardiac anaesthesia; Cardiac surgery; Risk prediction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram
Fig. 2
Fig. 2
Median and 25-75th percentiles of suPAR and hsCRP in relation to AKI severity
Fig. 3
Fig. 3
Scatterplot with preoperative eGFR and preoperative log2-transformed suPAR values
Fig. 4
Fig. 4
Adjusted odds ratios for AKI development (any stage) according to empirical quartiles of suPAR and hsCRP. Models were adjusted for age, sex, diabetes mellitus, arterial hypertension, preoperative ejection fraction, preoperative creatinine and CPB time. p values <0.05 is written in bold.
Fig. 5
Fig. 5
Receiver Operating Characteristic (ROC) curve and AUC for preoperative suPAR and hsCRP values
See this image and copyright information in PMC

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