Division of Pediatric Critical Care, Children's Memorial Hospital, Chicago, IL, USA.
Pediatr Crit Care Med. 2012 Jul;13(4):435-40. doi: 10.1097/PCC.0b013e318238b43c.
Acute kidney injury is a frequent and serious complication of cardiopulmonary bypass. In current clinical practice, serum creatinine is used to detect acute kidney injury. Cystatin C is a novel biomarker for kidney function that has been shown to be superior to serum creatinine in predicting acute kidney injury in adults after cardiopulmonary bypass. The aim of this study was to determine whether early cystatin C levels predict acute kidney injury associated with cardiopulmonary bypass in pediatric patients undergoing cardiac surgery and if cystatin C could predict pediatric-modified RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) class and renal injury as determined by estimated glomerular filtration rate. We also investigated whether ultrafiltration during cardiopulmonary bypass affects cystatin C levels.
Prospective, observational cohort study.
Cardiac intensive care unit in a tertiary, academic pediatric hospital.
One hundred pediatric patients who underwent cardiac surgery involving cardiopulmonary bypass.
None.
Acute kidney injury was defined as a 50% increase in serum creatinine from a preoperative baseline anytime through postoperative day 4. Severity of acute kidney injury was determined by pediatric RIFLE class using estimated glomerular filtration rate criteria only. Renal injury was also determined by an absolute estimated glomerular filtration rate <80 mL/min/1.73 m. Cystatin C levels were measured before and after ultrafiltration. Twenty-eight patients (28%) developed acute kidney injury. Cystatin C predicted acute kidney injury as early as 8 hrs after surgery. When applying pediatric RIFLE criteria to the entire study, 30 patients reached "risk" and five developed "injury." Cystatin C was a good predictor of the development of "injury" (under the receiver operating characteristic curve, 0.834-0.875) and of renal injury by estimated glomerular filtration rate (under the receiver operating characteristic curve, 0.717-0.835) (all p < .05). Cystatin C levels decreased perioperatively and correlated with volume of fluid removed by ultrafiltration.
Cystatin C is an early predictor of acute kidney injury in children after cardiopulmonary bypass. Cystatin C is a good predictor of pediatric RIFLE classification and of decreased estimated glomerular filtration rate after cardiopulmonary bypass. Serum cystatin C may be cleared by ultrafiltration.
急性肾损伤是体外循环的常见且严重的并发症。在当前的临床实践中，血清肌酐用于检测急性肾损伤。胱抑素 C 是一种新型的肾功能生物标志物，已被证明在预测体外循环后成人急性肾损伤方面优于血清肌酐。本研究旨在确定早期胱抑素 C 水平是否可预测小儿心脏手术患者体外循环相关的急性肾损伤，以及胱抑素 C 是否可预测小儿改良 RIFLE（风险、损伤、衰竭、丧失、终末期肾病）分级和肾小球滤过率估计值确定的肾损伤。我们还研究了体外循环期间超滤是否会影响胱抑素 C 水平。
前瞻性观察队列研究。
三级学术儿科医院的心脏重症监护病房。
100 名接受体外循环心脏手术的小儿患者。
无。
急性肾损伤定义为术后 4 天内血清肌酐比术前基线水平升高 50%。急性肾损伤的严重程度通过小儿 RIFLE 分级使用肾小球滤过率标准确定。肾损伤也通过绝对肾小球滤过率<80mL/min/1.73m 确定。在超滤前后测量胱抑素 C 水平。28 名患者（28%）发生急性肾损伤。胱抑素 C 早在术后 8 小时即可预测急性肾损伤。当将小儿 RIFLE 标准应用于整个研究时，30 名患者达到“风险”，5 名患者出现“损伤”。胱抑素 C 是发生“损伤”的良好预测因子（在受试者工作特征曲线下，0.834-0.875），通过肾小球滤过率估计值预测肾损伤（在受试者工作特征曲线下，0.717-0.835）（均 p<.05）。胱抑素 C 水平在围手术期下降，并与超滤去除的液体量相关。
胱抑素 C 是小儿体外循环后急性肾损伤的早期预测因子。胱抑素 C 是小儿 RIFLE 分级和体外循环后肾小球滤过率下降的良好预测因子。血清胱抑素 C 可能通过超滤清除。
