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Observational Study
. 2021 Sep 1;133(3):570-577.
doi: 10.1213/ANE.0000000000005650.

Associations Between Preoperative Biomarkers and Cardiac Surgery-Associated Acute Kidney Injury in Elderly Patients: A Cohort Study

Lisa Verwijmeren  1 , Madeleen Bosma  2 , Lisette M Vernooij  1 , Esther M Linde  1 , Ineke M Dijkstra  2 , Edgar J Daeter  3 , Eric P A Van Dongen  1 , Wilton A Van Klei  4 , Peter G Noordzij  1
Affiliations
Observational Study

Associations Between Preoperative Biomarkers and Cardiac Surgery-Associated Acute Kidney Injury in Elderly Patients: A Cohort Study

Lisa Verwijmeren et al. Anesth Analg. .

Abstract

Background: Acute kidney injury (AKI) is associated with mortality after cardiac surgery. Novel risk factors may improve identification of patients at risk for renal injury. The authors evaluated the association between preoperative biomarkers that reflect cardiac, inflammatory, renal, and metabolic disorders and cardiac surgery-associated AKI (CSA-AKI) in elderly patients.

Methods: This was a secondary analysis of the 2-center prospective cohort study "Anesthesia Geriatric Evaluation." Twelve biomarkers were determined preoperatively in 539 patients. Primary outcome was CSA-AKI. The association between biomarkers and CSA-AKI was investigated with multivariable logistic regression analysis. Secondary outcomes were 1-year mortality and patient-reported disability and were assessed with relative risks (RR) between patients with and without CSA-AKI.

Results: CSA-AKI occurred in 88 (16.3%) patients and was associated with increased risk of mortality (RR, 6.70 [95% confidence interval {CI}, 3.38-13.30]) and disability (RR, 2.13 [95% CI, 1.53-2.95]). Preoperative concentrations of N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), hemoglobin, and magnesium had the strongest association with CSA-AKI. Identification of patients with CSA-AKI improved when a biomarker panel was used (area under the curve [AUC] 0.75 [95% CI, 0.69-0.80]) compared to when only clinical risk factors were used (European System for Cardiac Operative Risk Evaluation [EuroSCORE II] AUC 0.67 [95% CI, 0.62-0.73]).

Conclusions: Preoperative cardiac, inflammatory, renal, and metabolic biomarkers are associated with CSA-AKI and may improve identification of patients at risk.

Trial registration: ClinicalTrials.gov NCT02535728.

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Conflict of interest statement

Conflicts of Interest: See Disclosures at the end of the article.

References

    1. O’Neal JB, Shaw AD, Billings FT IV. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016;20:187.
    1. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006;1:19–32.
    1. Enger TB, Pleym H, Stenseth R, Greiff G, Wahba A, Videm V. A preoperative multimarker approach to evaluate acute kidney injury after cardiac surgery. J Cardiothorac Vasc Anesth. 2017;31:837–846.
    1. Loef BG, Epema AH, Smilde TD, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol. 2005;16:195–200.
    1. Lopez-Delgado JC, Esteve F, Torrado H, et al. Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: risk factors and prognostic value of a modified RIFLE classification. Crit Care. 2013;17:R293.

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