The predictive value of the intraoperative Renal Pulsatility Index for acute kidney injury in patients undergoing cardiac surgery

2020 ◽  
Vol 86 (11) ◽  
Author(s):  
Hui Zhang ◽  
Kang Zhou ◽  
Dongyue Wang ◽  
Na Zhang ◽  
Jindong Liu
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Predictive Value ◽  
Pulsatility Index ◽  
Kidney Injury

Comparison of Predictive Value of Preoperative and Immediate Postoperative Proteinuria With Cardiac Surgery-associated Acute Kidney Injury

2018 ◽  
Vol 27 ◽  
pp. S522-S523
Author(s):  
Shahrul Hashim ◽  
Yeong Sing Lee ◽  
Kenny Cheng ◽  
Ashvin Nair ◽  
Sivakumar Krishnasamy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Predictive Value ◽  
Kidney Injury

scholarly journals Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Cardiac Surgery-Associated Acute Kidney Injury and Its Correlation with Long-Term Major Adverse Events

2019 ◽  
Vol 44 (3) ◽  
pp. 415-425
Author(s):  
Miaolin Che ◽  
Xudong Wang ◽  
Bo Xie ◽  
Ritai Huang ◽  
Shang Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Adverse Events ◽  
Predictive Value ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Single Marker ◽  
Major Adverse Events

Background/Aims: Cardiac surgery-associated acute kidney injury (CSA-AKI) was traditionally defined as an increase in serum creatinine (sCr) after cardiac surgery. Recently, serum cystatin C (sCyC) has been proposed to be a better biomarker in the prediction of AKI. The clinical utility and performance of combining sCyC and sCr in patients with AKI, particularly for the prediction of long-term outcomes, remain unknown. Methods: We measured sCyC together with sCr in 628 patients undergoing cardiac surgery. sCyC and sCr were assessed at baseline and 24 and 48 h after surgery. CSA-AKI determined by sCr (CSA-AKIsCr) was defined as an sCr increase greater than 0.3 mg/dL or 50% from baseline. Major adverse events (MAEs; including death of any cause and dialysis) at 3 years were assessed. Results: CSA-AKIsCr developed in 178 patients (28.3%). Three-year follow-up was available for 621 patients; MAEs occurred in 42 patients (6.8%). An increase in sCyC concentration ≥30% within 48 h after surgery was detected in 228 patients (36.3%). This was the best sCyC cutoff for CSA-AKIsCr detection (negative predictive value = 88.8%, positive predictive value = 58.3%). To evaluate the use of both sCyC and sCr as CSA-AKI diagnostic criteria, we stratified patients into 3 groups: non-CSA-AKI, CSA-AKI detected by a single marker, and CSA-AKI detected by both markers. By multivariable logistic regression analysis, the independent predictors of MAEs at 3 years were group 2 (non-CSA-AKI group as the reference, CSA-AKI detected by a single marker: odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.27–9.58, p = 0.016), group 3 (CSA-AKI detected by both markers: OR = 5.12, 95% CI: 2.01–13.09; p = 0.001), and baseline glomerular filtration rate (OR = 2.24; 95% CI: 1.27–3.95; p = 0.005). Conclusion: Combining sCyC and sCr to diagnose CSA-AKI would be beneficial for risk stratification and prognosis in patients after cardiac surgery.

scholarly journals DIAGNOSTIC VALUE OF BIOMARKERS OF ACUTE KIDNEY INJURY DEVELOPMENT AFTER CARDIAC SURGERY PERFORMED IN THE CONDITIONS OF CARDIOPULMONARY BYPASS

2021 ◽  
Vol 20 (2) ◽  
pp. 45-55
Author(s):  
D.I. Krachak ◽  
◽  
◽  
I.P. Klimchuk ◽  
S.V. Mshar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Kidney Injury ◽  
Diagnostic Value ◽  
Early Postoperative Period ◽  
Diagnostic Efficiency

Objectives. To assess the diagnostic value of urinary lipocalin associated with neutrophil gelatinase (uNGAL) as a monomarker, as well as in combination with other indicators, in acute kidney injury (AKI) diagnosing in the early postoperative period in cardiac surgery patients. Material and methods. The analysis of 73 case histories of ICU patients after cardiac surgery in the conditions of cardiopulmonary bypass was performed. AKIN criteria were applied to diagnose AKI. The primary end point of the study was the postoperative level of uNGAL, the secondary end point was the indexed value of uNGAL. Results. 31 (42.4%) patients developed AKI (according to AKIN score). uNGAL had a very good level of diagnostic significance in detecting AKI (AUC 0.849, p=0.001) and its optimal cutoff level was more than 48.2 ng/ml within the time frame up to 12 hours after surgery. The diagnostic efficiency of the uNGAL test was: specificity - 88.1%, sensitivity - 67.74%, positive predictive value - 80.8%, negative predictive value - 78.7%, positive likelihood ratio - 5.57, negative likelihood ratio - 0.37. The ratio of uNGAL to leukocytes in the terms up to 12 hours after surgery demonstrated an excellent level of diagnostic value (AUC 0.920, p=0.001). The diagnostic efficiency of this indicator (more than 5.5 μg/1*10<sup>9</sup>) was: specificity - 94.74%, sensitivity - 73.68%, positive predictive value - 93.3%, negative predictive value - 78.3%, positive likelihood ratio - 14.0, negative likelihood ratio - 0.28. Conclusions. The diagnostic capabilities of uNGAL in detecting AKI in the early stages after cardiac surgery exceed the capabilities of serum creatinine traditionally used for this purpose. To improve the efficiency of AKI diagnosis in the early postoperative period, it is possible to use indexed indicators, for example, the ratio of uNGAL to leukocytes level in the patient’s blood.

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

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