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Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest

(1) Background: Acute kidney injury (AKI) is a common complication following thoracic aortic surgery (TAS), with moderate hypothermic circulatory arrest (MHCA). However, prediction of AKI with classical tools remains uncertain. Therefore, it was the aim of the present study to evaluate the role of n...

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Autores principales: Pilarczyk, Kevin, Panholzer, Bernd, Huenges, Katharina, Salem, Mohamed, Jacob, Toni, Cremer, Jochen, Haneya, Assad
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877349/
https://www.ncbi.nlm.nih.gov/pubmed/35207297
http://dx.doi.org/10.3390/jcm11041024
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author Pilarczyk, Kevin
Panholzer, Bernd
Huenges, Katharina
Salem, Mohamed
Jacob, Toni
Cremer, Jochen
Haneya, Assad
author_facet Pilarczyk, Kevin
Panholzer, Bernd
Huenges, Katharina
Salem, Mohamed
Jacob, Toni
Cremer, Jochen
Haneya, Assad
author_sort Pilarczyk, Kevin
collection PubMed
description (1) Background: Acute kidney injury (AKI) is a common complication following thoracic aortic surgery (TAS), with moderate hypothermic circulatory arrest (MHCA). However, prediction of AKI with classical tools remains uncertain. Therefore, it was the aim of the present study to evaluate the role of new biomarkers in patients after MHCA. (2) Methods: 101 consecutive patients were prospectively enrolled. Measurements of urinary [TIMP-2]*[IGFBP7] and Cystatin C in the blood were performed perioperatively. Primary endpoint was the occurrence of AKI stage 2 or 3 (KDIGO-classification) within 48 h after surgery (AKI group). (3) Results: Mean age of patients was 69.1 ± 10.9 years, 35 patients were female (34%), and 13 patients (13%) met the primary endpoint. Patients in the AKI group had a prolonged ICU-stay (6.9 ± 7.4 days vs. 2.5 ± 3.1 days, p < 0.001) as well as a higher 30-day-mortality (9/28 vs. 1/74, p < 0.001). Preoperative serum creatinine (169.73 ± 148.97 μmol/L vs. 89.74 ± 30.04 μmol/L, p = 0.027) as well as Cystatin C (2.41 ± 1.54 mg/L vs. 1.13 ± 0.35 mg/L, p = 0.029) were higher in these patients. [TIMP-2]*[IGFBP7] increased significantly four hours after surgery (0.6 ± 0.69 mg/L vs. 0.37 ± 0.56 mg/L, p = 0.03) in the AKI group. Preoperative Cystatin C (AUC 0.828, p < 0.001) and serum creatinine (AUC 0.686, p = 0.002) as well as [TIMP-2]*[IGFBP7] 4 h after surgery (AUC 0.724, p = 0.020) were able to predict postoperative AKI. The predictive capacity of Cystatin C was superior to serum creatinine (p = 0.0211) (4) Conclusion: Cystatin C represents a very sensitive and specific biomarker to predict AKI in patients undergoing thoracic surgery with MHCA even before surgery, whereas the predictive capacity of [TIMP-2]*[IGFBP7] is only moderate and inferior to that of serum creatinine.
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spelling pubmed-88773492022-02-26 Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest Pilarczyk, Kevin Panholzer, Bernd Huenges, Katharina Salem, Mohamed Jacob, Toni Cremer, Jochen Haneya, Assad J Clin Med Article (1) Background: Acute kidney injury (AKI) is a common complication following thoracic aortic surgery (TAS), with moderate hypothermic circulatory arrest (MHCA). However, prediction of AKI with classical tools remains uncertain. Therefore, it was the aim of the present study to evaluate the role of new biomarkers in patients after MHCA. (2) Methods: 101 consecutive patients were prospectively enrolled. Measurements of urinary [TIMP-2]*[IGFBP7] and Cystatin C in the blood were performed perioperatively. Primary endpoint was the occurrence of AKI stage 2 or 3 (KDIGO-classification) within 48 h after surgery (AKI group). (3) Results: Mean age of patients was 69.1 ± 10.9 years, 35 patients were female (34%), and 13 patients (13%) met the primary endpoint. Patients in the AKI group had a prolonged ICU-stay (6.9 ± 7.4 days vs. 2.5 ± 3.1 days, p < 0.001) as well as a higher 30-day-mortality (9/28 vs. 1/74, p < 0.001). Preoperative serum creatinine (169.73 ± 148.97 μmol/L vs. 89.74 ± 30.04 μmol/L, p = 0.027) as well as Cystatin C (2.41 ± 1.54 mg/L vs. 1.13 ± 0.35 mg/L, p = 0.029) were higher in these patients. [TIMP-2]*[IGFBP7] increased significantly four hours after surgery (0.6 ± 0.69 mg/L vs. 0.37 ± 0.56 mg/L, p = 0.03) in the AKI group. Preoperative Cystatin C (AUC 0.828, p < 0.001) and serum creatinine (AUC 0.686, p = 0.002) as well as [TIMP-2]*[IGFBP7] 4 h after surgery (AUC 0.724, p = 0.020) were able to predict postoperative AKI. The predictive capacity of Cystatin C was superior to serum creatinine (p = 0.0211) (4) Conclusion: Cystatin C represents a very sensitive and specific biomarker to predict AKI in patients undergoing thoracic surgery with MHCA even before surgery, whereas the predictive capacity of [TIMP-2]*[IGFBP7] is only moderate and inferior to that of serum creatinine. MDPI 2022-02-16 /pmc/articles/PMC8877349/ /pubmed/35207297 http://dx.doi.org/10.3390/jcm11041024 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Pilarczyk, Kevin
Panholzer, Bernd
Huenges, Katharina
Salem, Mohamed
Jacob, Toni
Cremer, Jochen
Haneya, Assad
Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
title Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
title_full Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
title_fullStr Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
title_full_unstemmed Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
title_short Prediction of Acute Kidney Injury by Cystatin C and [TIMP-2]*[IGFBP7] after Thoracic Aortic Surgery with Moderate Hypothermic Circulatory Arrest
title_sort prediction of acute kidney injury by cystatin c and [timp-2]*[igfbp7] after thoracic aortic surgery with moderate hypothermic circulatory arrest
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8877349/
https://www.ncbi.nlm.nih.gov/pubmed/35207297
http://dx.doi.org/10.3390/jcm11041024
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