Serum soluble triggering receptor levels expressed on myeloid cells2 identify early acute kidney injury in infants and young children after pediatric cardiopulmonary bypass

Abstract

Background: Acute kidney injury (AKI) is a potential complication after cardiopulmonary bypass (CPB) of pediatric cardiac surgery and contributes to a certain amount of perioperative mortality. Serum soluble triggering receptor expressed on myeloid cells2 (sTREM2) is an inflammation-associated cytokine in circulation. Alterations of sTREM2 level have been reported in Alzheimer's disease, sepsis, and some other pathologic conditions. This study aimed to investigate the role of sTREM2 as a forecasting factor for AKI in infants and young children and other factors associated with early renal injury after pediatric CPB.

Methods: A prospective cohort study with consecutive infants and young children ≤ 3 years old undergoing CPB from September 2021 to August 2022 was conducted in an affiliated university children's hospital. These patients were divided into an AKI group (n = 10) and a non-AKI group (n = 60). Children's characteristics and clinical data were measured. Perioperative sTREM2 levels were analyzed with enzyme-linked immunosorbent assay (ELISA).

Results: In children developing AKI, the sTREM2 levels significantly decreased at the beginning of CPB compared to the non-AKI group. Based on binary logistic regression analysis and multivariable regression analysis, risk-adjusted classification for congenital heart surgery (RACHS-1), operation time, and the s-TREM2 level at the beginning of CPB (AUC = 0.839, p = 0.001, optimal cut-off value: 716.0 pg/ml) had predictive value for post-CPB AKI. When combining the sTREM2 level at the beginning of CPB and other indicators together, the area under the ROC curve enlarged.

Conclusions: Operation time, RACHS-1 score, and sTREM2 level at the beginning of CPB were independent prognosis factors of post-CPB AKI in infants and young children ≤ 3 years old. Decreased sTREM2 identified post-CPB AKI, and ultimately hampered the outcomes. Our findings indicated that sTREM2 may be a protective factor for AKI after CPB in infants and young children ≤ 3 years old.

Keywords: acute kidney injury; cardiopulmonary bypass; prognostic factors; soluble TREM2; young children.

Figure 1

(A) Baseline levels and changes of sTREM2 for all the patients; (B) baseline levels and changes of sTREM2 for the patients in the AKI group and non-AKI group. AKI, acute kidney injury; sTREM2, serum soluble triggering receptor expressed on myeloid cells2.

Figure 2

(A) ROC curve for RACH-1 score, operation time, and the combination of RACH-1 score and operation time to predict post-CPB AKI; (B) ROC curve for sTREM2 level at t2, the combination of sTREM2 level at t2 with RACH-1 score, and the combination of sTREM2 level at t2 with operation time to predict post-CPB AKI. ROC, receiver operating characteristic; t2, time 2 (beginning of CPB); RACHS-1, risk-adjusted classification for congenital heart surgery.