Journal Article

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

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

2023

Overview

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.

• Publisher: Springer US,Springer,Springer Nature B.V
• Subject: Acute Kidney Injury - diagnosis / Acute Kidney Injury - etiology / Analysis / Biomarkers / Cardiac Surgery / Cardiac Surgical Procedures - adverse effects / Cardiology / Cardiopulmonary Bypass - adverse effects / Coronary artery bypass / Creatinine / Cystatin C / Extracorporeal membrane oxygenation / Extubation / Health aspects / Heart surgery / Humans / Infant / Kidney diseases / Kidneys / Laboratories / Medicine / Medicine & Public Health / Mortality / Pediatric cardiology / Prospective Studies / Standard of care / Surgery / Tranexamic acid / Urine / Vascular Surgery