Using Serum Cystatin C to Predict Acute Kidney Injury Following Infant Cardiac Surgery

Maher Abadeer; Michael F. Swartz; Susan D. Martin; Angela M. Groves; Alison L. Kent; George J. Schwartz; Patrick Brophy; George M. Alfieris; Jill M. Cholette

doi:10.1007/s00246-022-03080-y

Using Serum Cystatin C to Predict Acute Kidney Injury Following Infant Cardiac Surgery

Maher Abadeer, Michael F. Swartz, Susan D. Martin, Angela M. Groves, Alison L. Kent, George J. Schwartz, Patrick Brophy, George M. Alfieris, Jill M. Cholette^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

Abstract

Acute kidney injury (AKI) following cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality. Serum Cystatin C (CysC) is a novel biomarker synthesized by all nucleated cells that may act as an early indicator of AKI following infant CPB. Prospective observational study of infants (< 1 year) requiring CPB during cardiac surgery. CysC was measured at baseline and 12, 24, 48, and 72 h following CPB initiation. Each post-op percent difference in CysC (e.g. %CysC_12h) from baseline was calculated. Clinical variables along with urine output (UOP) and serum creatinine (SCr) were followed. Subjects were divided into two groups: AKI and non-AKI based upon the Kidney Disease Improving Global Outcomes (KDIGO) classification. AKI occurred in 41.9% (18) of the 43 infants enrolled. Patient demographics and baseline CysC levels were similar between groups. CysC levels were 0.97 ± 0.28 mg/L over the study period, and directly correlated with SCr (R = 0.71, p < 0.0001). Although absolute CysC levels were not significant between groups, the %CysC_12h was significantly greater in the AKI group (AKI: − 16% ± 22% vs. Non-AKI − 28% ± 9% mg/L; p = 0.003). However, multivariate analysis demonstrated that a lower UOP (Odds Ratio:0.298; 95% CI 0.073, 0.850; p = 0.02) but not %CysC_12h was independently associated with AKI. Despite a significant difference in the %CysC_12h, only UOP was independently associated with AKI. Larger studies of a more homogenous population are needed to understand these results and to explore the variability in this biomarker seen across institutions.

Original language	English
Pages (from-to)	855-866
Number of pages	12
Journal	Pediatric Cardiology
Volume	44
Issue number	4
DOIs	https://doi.org/10.1007/s00246-022-03080-y
Publication status	Published - Apr 2023

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@article{c723430aa5084838a2ad3a94cd281fb4,

title = "Using Serum Cystatin C to Predict Acute Kidney Injury Following Infant Cardiac Surgery",

abstract = "Acute kidney injury (AKI) following cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality. Serum Cystatin C (CysC) is a novel biomarker synthesized by all nucleated cells that may act as an early indicator of AKI following infant CPB. Prospective observational study of infants (< 1 year) requiring CPB during cardiac surgery. CysC was measured at baseline and 12, 24, 48, and 72 h following CPB initiation. Each post-op percent difference in CysC (e.g. %CysC12h) from baseline was calculated. Clinical variables along with urine output (UOP) and serum creatinine (SCr) were followed. Subjects were divided into two groups: AKI and non-AKI based upon the Kidney Disease Improving Global Outcomes (KDIGO) classification. AKI occurred in 41.9% (18) of the 43 infants enrolled. Patient demographics and baseline CysC levels were similar between groups. CysC levels were 0.97 ± 0.28 mg/L over the study period, and directly correlated with SCr (R = 0.71, p < 0.0001). Although absolute CysC levels were not significant between groups, the %CysC12h was significantly greater in the AKI group (AKI: − 16% ± 22% vs. Non-AKI − 28% ± 9% mg/L; p = 0.003). However, multivariate analysis demonstrated that a lower UOP (Odds Ratio:0.298; 95% CI 0.073, 0.850; p = 0.02) but not %CysC12h was independently associated with AKI. Despite a significant difference in the %CysC12h, only UOP was independently associated with AKI. Larger studies of a more homogenous population are needed to understand these results and to explore the variability in this biomarker seen across institutions.",

keywords = "Biomarker, Cardiac surgery, Kidney injury, Pediatric",

author = "Maher Abadeer and Swartz, {Michael F.} and Martin, {Susan D.} and Groves, {Angela M.} and Kent, {Alison L.} and Schwartz, {George J.} and Patrick Brophy and Alfieris, {George M.} and Cholette, {Jill M.}",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2023",

month = apr,

doi = "10.1007/s00246-022-03080-y",

language = "English",

volume = "44",

pages = "855--866",

journal = "Pediatric Cardiology",

issn = "0172-0643",

publisher = "Springer New York",

number = "4",

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T1 - Using Serum Cystatin C to Predict Acute Kidney Injury Following Infant Cardiac Surgery

AU - Abadeer, Maher

AU - Swartz, Michael F.

AU - Martin, Susan D.

AU - Groves, Angela M.

AU - Kent, Alison L.

AU - Schwartz, George J.

AU - Brophy, Patrick

AU - Alfieris, George M.

AU - Cholette, Jill M.

PY - 2023/4

Y1 - 2023/4

N2 - Acute kidney injury (AKI) following cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality. Serum Cystatin C (CysC) is a novel biomarker synthesized by all nucleated cells that may act as an early indicator of AKI following infant CPB. Prospective observational study of infants (< 1 year) requiring CPB during cardiac surgery. CysC was measured at baseline and 12, 24, 48, and 72 h following CPB initiation. Each post-op percent difference in CysC (e.g. %CysC12h) from baseline was calculated. Clinical variables along with urine output (UOP) and serum creatinine (SCr) were followed. Subjects were divided into two groups: AKI and non-AKI based upon the Kidney Disease Improving Global Outcomes (KDIGO) classification. AKI occurred in 41.9% (18) of the 43 infants enrolled. Patient demographics and baseline CysC levels were similar between groups. CysC levels were 0.97 ± 0.28 mg/L over the study period, and directly correlated with SCr (R = 0.71, p < 0.0001). Although absolute CysC levels were not significant between groups, the %CysC12h was significantly greater in the AKI group (AKI: − 16% ± 22% vs. Non-AKI − 28% ± 9% mg/L; p = 0.003). However, multivariate analysis demonstrated that a lower UOP (Odds Ratio:0.298; 95% CI 0.073, 0.850; p = 0.02) but not %CysC12h was independently associated with AKI. Despite a significant difference in the %CysC12h, only UOP was independently associated with AKI. Larger studies of a more homogenous population are needed to understand these results and to explore the variability in this biomarker seen across institutions.

AB - Acute kidney injury (AKI) following cardiopulmonary bypass (CPB) is associated with increased morbidity and mortality. Serum Cystatin C (CysC) is a novel biomarker synthesized by all nucleated cells that may act as an early indicator of AKI following infant CPB. Prospective observational study of infants (< 1 year) requiring CPB during cardiac surgery. CysC was measured at baseline and 12, 24, 48, and 72 h following CPB initiation. Each post-op percent difference in CysC (e.g. %CysC12h) from baseline was calculated. Clinical variables along with urine output (UOP) and serum creatinine (SCr) were followed. Subjects were divided into two groups: AKI and non-AKI based upon the Kidney Disease Improving Global Outcomes (KDIGO) classification. AKI occurred in 41.9% (18) of the 43 infants enrolled. Patient demographics and baseline CysC levels were similar between groups. CysC levels were 0.97 ± 0.28 mg/L over the study period, and directly correlated with SCr (R = 0.71, p < 0.0001). Although absolute CysC levels were not significant between groups, the %CysC12h was significantly greater in the AKI group (AKI: − 16% ± 22% vs. Non-AKI − 28% ± 9% mg/L; p = 0.003). However, multivariate analysis demonstrated that a lower UOP (Odds Ratio:0.298; 95% CI 0.073, 0.850; p = 0.02) but not %CysC12h was independently associated with AKI. Despite a significant difference in the %CysC12h, only UOP was independently associated with AKI. Larger studies of a more homogenous population are needed to understand these results and to explore the variability in this biomarker seen across institutions.

KW - Biomarker

KW - Cardiac surgery

KW - Kidney injury

KW - Pediatric

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U2 - 10.1007/s00246-022-03080-y

DO - 10.1007/s00246-022-03080-y

M3 - Article

SN - 0172-0643

VL - 44

SP - 855

EP - 866

JO - Pediatric Cardiology

JF - Pediatric Cardiology

IS - 4

ER -

Using Serum Cystatin C to Predict Acute Kidney Injury Following Infant Cardiac Surgery

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