Department of anaesthesia and intensive care II, Bordeaux university hospital, 33000 Bordeaux, France.
Department of anaesthesia and intensive care II, Bordeaux university hospital, 33000 Bordeaux, France.
Anaesth Crit Care Pain Med. 2018 Aug;37(4):335-341. doi: 10.1016/j.accpm.2018.05.001. Epub 2018 May 17.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent complication. The current criteria to detect CSA-AKI rise only when organic dysfunction has occurred. The Doppler Renal Resistive Index (RRI) and the urinary G1 cell cycle arrest proteins (TIMP-2 and IGFBP7) have been advocated to predict CSA-AKI at an early stage after cardiac surgery. The primary objective was to determine the predictive value of these new markers to detect CSA-AKI after elective heart surgery in patients at risk to develop AKI.
In a prospective observational trial, we studied 50 patients scheduled for elective on-pump heart surgery at high risk for CSA-AKI. The primary outcome was the incidence of AKI according to the KDIGO criteria recording the urine output every hour until ICU discharge and measuring the serum creatinine levels on each postoperative day until the post-procedure peak values were reached or until the 7th postoperative day. The RRI and the urinary proteins [TIMP-2]*[IGFBP7] were measured concomitantly: before surgery, 1hour (H1), 4-hour (H4), 12-hour (H12), and 24-hour (H24) after surgery.
Thirty-seven patients (74%) developed CSA-AKI. Urinary [TIMP-2][IGFBP7] at H12 were significantly higher in patients that developed AKI (0.62, [interquartile] [0.20-1.18] vs. 0.30 [0.07-0.47] P=0.044) with an area under the receiver-operating characteristic curve of 0.69 [0.53-0.84]. The best sensitivity (65%) and specificity (62%) was achieved for a cutoff value of 0.3 (ng.mL).1000. The H12 time-point was the only in which the RRI values measured showed a trend toward statistical significance in patients that developed AKI (0.72 (Standard deviation)±(0.06) vs. 0.68±(0.07) P=0.065). The combination of the two markers ([TIMP-2][IGFBP7]+RRI) at H12 showed an increased performance of the accuracy with an area under the receiver-operating characteristic curve of 0.78 [0.62-0.93].
In a population at risk of developing CSA-AKI, neither the RRI nor urinary [TIMP-2]*[IGFBP7] detect CSA-AKI occurring in the first post-operative week within the first 24 postoperative hours.
心脏手术相关的急性肾损伤（CSA-AKI）是一种常见的并发症。目前，检测 CSA-AKI 的标准仅在发生器官功能障碍时升高。多普勒肾阻力指数（RRI）和尿 G1 细胞周期阻滞蛋白（TIMP-2 和 IGFBP7）已被用于预测心脏手术后早期 CSA-AKI。主要目的是确定这些新标志物在高危发生 AKI 的择期心脏手术患者中检测 CSA-AKI 的预测价值。
在一项前瞻性观察性试验中，我们研究了 50 名接受择期体外循环心脏手术的高危 CSA-AKI 患者。主要结局是根据 KDIGO 标准记录每小时尿量直至 ICU 出院，并在术后每天测量血清肌酐水平，直到达到术后峰值或直到术后第 7 天，记录 AKI 的发生率。同时测量 RRI 和尿蛋白 [TIMP-2]*[IGFBP7]：术前、术后 1 小时（H1）、4 小时（H4）、12 小时（H12）和 24 小时（H24）。
37 名患者（74%）发生 CSA-AKI。发生 AKI 的患者尿 [TIMP-2][IGFBP7]在 H12 时明显升高（0.62，[四分位距] [0.20-1.18] vs. 0.30 [0.07-0.47] P=0.044），受试者工作特征曲线下面积为 0.69 [0.53-0.84]。当截断值为 0.3（ng.mL）时，获得最佳的敏感性（65%）和特异性（62%）。在发生 AKI 的患者中，仅在 H12 时 RRI 值测量显示出统计学意义的趋势（0.72（标准差）±（0.06） vs. 0.68±（0.07） P=0.065）。在 H12 时，两种标志物（[TIMP-2][IGFBP7]+RRI）的联合使用提高了准确性，受试者工作特征曲线下面积为 0.78 [0.62-0.93]。
在发生 CSA-AKI 风险的人群中，RRI 或尿 [TIMP-2]*[IGFBP7]均无法在术后 24 小时内检测到术后第 1 周内发生的 CSA-AKI。
