Department of Nephrology, Zhongshan Hospital, Fudan University, No 180 Fenglin Rd, Shanghai, China.
Department of Cardiac Surgery Intensive Care Unit, Zhongshan Hospital, Fudan University, No 180 Fenglin Rd, Shanghai, China.
BMC Cardiovasc Disord. 2024 Aug 9;24(1):414. doi: 10.1186/s12872-024-04061-0.
The development of acute kidney injury (AKI) post-cardiac surgery significantly increases patient morbidity and healthcare costs. Prior researches have established Syndecan-1 (SDC-1) as a potential biomarker for endothelial injury and subsequent acute kidney injury development. This study assessed whether postoperative SDC-1 levels could further predict AKI requiring kidney replacement therapy (AKI-KRT) and AKI progression.
In this prospective study, 122 adult cardiac surgery patients, who underwent valve or coronary artery bypass grafting (CABG) or a combination thereof and developed AKI within 48 h post-operation from May to September 2021, were monitored for the progression to stage 2-3 AKI or the need for KRT. We analyzed the predictive value of postoperative serum SDC-1 levels in relation to multiple endpoints.
In the study population, 110 patients (90.2%) underwent cardiopulmonary bypass, of which thirty received CABG or combined surgery. Fifteen patients (12.3%) required KRT, and thirty-eight (31.1%) developed progressive AKI, underscoring the severe AKI incidence. Multivariate logistic regression indicated that elevated SDC-1 levels were independent risk factors for progressive AKI (OR = 1.006) and AKI-KRT (OR = 1.011). The AUROC for SDC-1 levels in predicting AKI-KRT and AKI progression was 0.892 and 0.73, respectively, outperforming the inflammatory cytokines. Linear regression revealed a positive correlation between SDC-1 levels and both hospital (β = 0.014, p = 0.022) and ICU stays (β = 0.013, p < 0.001).
Elevated postoperative SDC-1 levels significantly predict AKI progression and AKI-KRT in patients following cardiac surgery. The study's findings support incorporating SDC-1 level monitoring into post-surgical care to improve early detection and intervention for severe AKI.
心脏手术后急性肾损伤（AKI）的发展显著增加了患者的发病率和医疗保健成本。先前的研究已经确定 syndecan-1（SDC-1）作为内皮损伤和随后急性肾损伤发展的潜在生物标志物。本研究评估了术后 SDC-1 水平是否可以进一步预测需要肾脏替代治疗（AKI-KRT）的 AKI 和 AKI 进展。
在这项前瞻性研究中，监测了 122 名成年心脏手术患者的进展情况，这些患者在 2021 年 5 月至 9 月期间接受了瓣膜或冠状动脉旁路移植术（CABG）或两者的联合手术，并在术后 48 小时内发生 AKI，以确定是否进展为 2-3 期 AKI 或需要 KRT。我们分析了术后血清 SDC-1 水平与多个终点的预测价值。
在研究人群中，110 名患者（90.2%）接受了心肺旁路，其中 30 名患者接受了 CABG 或联合手术。15 名患者（12.3%）需要 KRT，38 名患者（31.1%）发生了进行性 AKI，这突显了严重 AKI 的发生率。多变量逻辑回归表明，SDC-1 水平升高是进行性 AKI（OR=1.006）和 AKI-KRT（OR=1.011）的独立危险因素。SDC-1 水平预测 AKI-KRT 和 AKI 进展的 AUROC 分别为 0.892 和 0.73，优于炎症细胞因子。线性回归显示 SDC-1 水平与住院时间（β=0.014，p=0.022）和 ICU 住院时间（β=0.013，p<0.001）呈正相关。
心脏手术后患者术后 SDC-1 水平升高显著预测 AKI 进展和 AKI-KRT。该研究的结果支持将 SDC-1 水平监测纳入术后护理，以改善严重 AKI 的早期检测和干预。
