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 journalArticlepeer-review

98 Scopus citations


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 languageEnglish (US)
Pages (from-to)655-662
Number of pages8
JournalKidney international
Issue number6
StatePublished - Sep 2 2011
Externally publishedYes


  • acute renal failure
  • cardiovascular
  • creatinine
  • epidemiology and outcomes
  • renal function

ASJC Scopus subject areas

  • Nephrology


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