Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

Michael Zappitelli; Catherine D. Krawczeski; Prasad Devarajan; Zhu Wang; Kyaw Sint; Heather Thiessen-Philbrook; Simon Li; Michael R. Bennett; Qing Ma; Michael G. Shlipak; Amit X. Garg; Chirag R. Parikh

doi:10.1038/ki.2011.123

Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

Michael Zappitelli, Catherine D. Krawczeski, Prasad Devarajan, Zhu Wang, Kyaw Sint, Heather Thiessen-Philbrook, Simon Li, Michael R. Bennett, Qing Ma, Michael G. Shlipak, Amit X. Garg, Chirag R. Parikh

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

98 Scopus citations

Abstract

In this multicenter, prospective study of 288 children (half under 2 years of age) undergoing cardiac surgery, we evaluated whether the measurement of pre-and postoperative serum cystatin C (CysC) improves the prediction of acute kidney injury (AKI) over that obtained by serum creatinine (SCr). Higher preoperative SCr-based estimated glomerular filtration rates predicted higher risk of the postoperative primary outcomes of stage 1 and 2 AKI (adjusted odds ratios (ORs) 1.5 and 1.9, respectively). Preoperative CysC was not associated with AKI. The highest quintile of postoperative (within 6 h) CysC predicted stage 1 and 2 AKI (adjusted ORs of 6 and 17.2, respectively). The highest tertile of percent change in CysC independently predicted AKI, whereas the highest tertile of SCr predicted stage 1 but not stage 2 AKI. Postoperative CysC levels independently predicted longer duration of ventilation and intensive care unit length of stay, whereas the postoperative SCr change only predicted longer intensive care unit stay. Thus, postoperative serum CysC is useful to risk-stratify patients for AKI treatment trials. More research, however, is needed to understand the relation between preoperative renal function and the risk of AKI.

Original language	English (US)
Pages (from-to)	655-662
Number of pages	8
Journal	Kidney international
Volume	80
Issue number	6
DOIs	https://doi.org/10.1038/ki.2011.123
State	Published - Sep 2 2011
Externally published	Yes

Keywords

acute renal failure
cardiovascular
creatinine
epidemiology and outcomes
renal function

ASJC Scopus subject areas

Nephrology

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10.1038/ki.2011.123

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@article{199f69cba9984b9c9f8ce7a4c8a13b99,

title = "Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery",

abstract = "In this multicenter, prospective study of 288 children (half under 2 years of age) undergoing cardiac surgery, we evaluated whether the measurement of pre-and postoperative serum cystatin C (CysC) improves the prediction of acute kidney injury (AKI) over that obtained by serum creatinine (SCr). Higher preoperative SCr-based estimated glomerular filtration rates predicted higher risk of the postoperative primary outcomes of stage 1 and 2 AKI (adjusted odds ratios (ORs) 1.5 and 1.9, respectively). Preoperative CysC was not associated with AKI. The highest quintile of postoperative (within 6 h) CysC predicted stage 1 and 2 AKI (adjusted ORs of 6 and 17.2, respectively). The highest tertile of percent change in CysC independently predicted AKI, whereas the highest tertile of SCr predicted stage 1 but not stage 2 AKI. Postoperative CysC levels independently predicted longer duration of ventilation and intensive care unit length of stay, whereas the postoperative SCr change only predicted longer intensive care unit stay. Thus, postoperative serum CysC is useful to risk-stratify patients for AKI treatment trials. More research, however, is needed to understand the relation between preoperative renal function and the risk of AKI.",

keywords = "acute renal failure, cardiovascular, creatinine, epidemiology and outcomes, renal function",

author = "Michael Zappitelli and Krawczeski, {Catherine D.} and Prasad Devarajan and Zhu Wang and Kyaw Sint and Heather Thiessen-Philbrook and Simon Li and Bennett, {Michael R.} and Qing Ma and Shlipak, {Michael G.} and Garg, {Amit X.} and Parikh, {Chirag R.}",

note = "Funding Information: The study was supported by the NIH grant to CRP (RO1-HL085757). MZ received research support from the Kidney Research Core Education and National Training Program, the Montreal Children's Hospital Research Institute and the Fondation de Recherche en Sante du Quebec. AXG was supported by a Clinician Scientist Award from the Canadian Institutes of Health Research. We thank the study site research co-ordinators who meticulously performed the study procedures and data entry and the hospital staff for obtaining preoperative blood specimens. We sincerely thank A Piepsz (Brussels, Belgium) for sharing her data on nuclear medicine technology-measured GFR in children with normal kidney function, which we used to generate our GFR percentile values.",

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doi = "10.1038/ki.2011.123",

language = "English (US)",

volume = "80",

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journal = "Kidney international",

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T1 - Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

AU - Zappitelli, Michael

AU - Krawczeski, Catherine D.

AU - Devarajan, Prasad

AU - Wang, Zhu

AU - Sint, Kyaw

AU - Thiessen-Philbrook, Heather

AU - Li, Simon

AU - Bennett, Michael R.

AU - Ma, Qing

AU - Shlipak, Michael G.

AU - Garg, Amit X.

AU - Parikh, Chirag R.

N1 - Funding Information: The study was supported by the NIH grant to CRP (RO1-HL085757). MZ received research support from the Kidney Research Core Education and National Training Program, the Montreal Children's Hospital Research Institute and the Fondation de Recherche en Sante du Quebec. AXG was supported by a Clinician Scientist Award from the Canadian Institutes of Health Research. We thank the study site research co-ordinators who meticulously performed the study procedures and data entry and the hospital staff for obtaining preoperative blood specimens. We sincerely thank A Piepsz (Brussels, Belgium) for sharing her data on nuclear medicine technology-measured GFR in children with normal kidney function, which we used to generate our GFR percentile values.

PY - 2011/9/2

Y1 - 2011/9/2

N2 - In this multicenter, prospective study of 288 children (half under 2 years of age) undergoing cardiac surgery, we evaluated whether the measurement of pre-and postoperative serum cystatin C (CysC) improves the prediction of acute kidney injury (AKI) over that obtained by serum creatinine (SCr). Higher preoperative SCr-based estimated glomerular filtration rates predicted higher risk of the postoperative primary outcomes of stage 1 and 2 AKI (adjusted odds ratios (ORs) 1.5 and 1.9, respectively). Preoperative CysC was not associated with AKI. The highest quintile of postoperative (within 6 h) CysC predicted stage 1 and 2 AKI (adjusted ORs of 6 and 17.2, respectively). The highest tertile of percent change in CysC independently predicted AKI, whereas the highest tertile of SCr predicted stage 1 but not stage 2 AKI. Postoperative CysC levels independently predicted longer duration of ventilation and intensive care unit length of stay, whereas the postoperative SCr change only predicted longer intensive care unit stay. Thus, postoperative serum CysC is useful to risk-stratify patients for AKI treatment trials. More research, however, is needed to understand the relation between preoperative renal function and the risk of AKI.

AB - In this multicenter, prospective study of 288 children (half under 2 years of age) undergoing cardiac surgery, we evaluated whether the measurement of pre-and postoperative serum cystatin C (CysC) improves the prediction of acute kidney injury (AKI) over that obtained by serum creatinine (SCr). Higher preoperative SCr-based estimated glomerular filtration rates predicted higher risk of the postoperative primary outcomes of stage 1 and 2 AKI (adjusted odds ratios (ORs) 1.5 and 1.9, respectively). Preoperative CysC was not associated with AKI. The highest quintile of postoperative (within 6 h) CysC predicted stage 1 and 2 AKI (adjusted ORs of 6 and 17.2, respectively). The highest tertile of percent change in CysC independently predicted AKI, whereas the highest tertile of SCr predicted stage 1 but not stage 2 AKI. Postoperative CysC levels independently predicted longer duration of ventilation and intensive care unit length of stay, whereas the postoperative SCr change only predicted longer intensive care unit stay. Thus, postoperative serum CysC is useful to risk-stratify patients for AKI treatment trials. More research, however, is needed to understand the relation between preoperative renal function and the risk of AKI.

KW - acute renal failure

KW - cardiovascular

KW - creatinine

KW - epidemiology and outcomes

KW - renal function

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VL - 80

SP - 655

EP - 662

JO - Kidney international

JF - Kidney international

IS - 6

ER -

Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

Abstract

Keywords

ASJC Scopus subject areas

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