Rahaman M S, Rony M M R, Hossain M S, Hoque M M, Hossain M M, Shahazadi I, Raha S K, Hasan M K, Jahan A B M
Dr Md Salahuddin Rahaman, Assistant Registrar, Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2025 Apr;34(2):482-490.
Acute kidney injury (AKI) following adult cardiac surgery procedures under Cardio-pulmonary bypass (CPB) is linked to a higher risk of morbidity and death. As a novel biomarker for renal failure, serum Cystatin C (CysC) is of prognostic value; however, a wide range of its predictive accuracy has been reported. The study aimed to evaluate whether early postoperative serum CysC measurement improves the prediction of AKI following adult cardiac surgery and determine the relationship between the measurement of early postoperative serum CysC level and post-operative early outcomes. In a single-center, prospective study of 70 patients was conducted at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh from July 2018 to December 2019 who underwent on-pump cardiac surgery. The study participants were chosen specifically because they had normal renal function and had had elective scheduled heart surgery under CPB. The blood samples were tested at six measurements time points (T1 preoperative, T2 at 6 hours after commencement of CPB, T3 at 12 hours after commencement of CPB, T4 at 24 hours after commencement of CPB, T5 at 36 hours after commencement of CPB and T6 at 48 hours after commencement of CPB). Serum cystatin C was significantly higher 12 hours after the commencement of CPB during operation (T3) and onwards when the earliest significant predictive AUCs were found (T3: AUC 0.983; p<0.0001; 95% CI, 0.960 to 1.000; T4-6: AUC 1.000; p<0.0001; 95% CI, 1.000). In summary, this study found that serum CysC is a useful early biomarker of AKI in adults following cardiac surgery, and the extent of this marker correlates with the severity of AKI.
体外循环（CPB）下进行成人心脏手术术后发生的急性肾损伤（AKI）与更高的发病和死亡风险相关。作为一种用于肾衰竭的新型生物标志物，血清胱抑素C（CysC）具有预后价值；然而，其预测准确性的范围差异较大。本研究旨在评估术后早期血清CysC检测是否能改善对成人心脏手术后AKI的预测，并确定术后早期血清CysC水平检测与术后早期结局之间的关系。2018年7月至2019年12月，在孟加拉国达卡的国家心血管疾病研究所（NICVD）对70例接受体外循环心脏手术的患者进行了一项单中心前瞻性研究。选择这些研究参与者是因为他们肾功能正常且接受了择期体外循环心脏手术。在六个测量时间点（T1术前、T2体外循环开始后6小时、T3体外循环开始后12小时、T4体外循环开始后24小时、T5体外循环开始后36小时和T6体外循环开始后48小时）采集血样进行检测。术中体外循环开始后12小时（T3）及之后血清胱抑素C显著升高，此时发现最早具有显著预测价值的曲线下面积（AUC）（T3：AUC 0.983；p<0.0001；95%CI，0.960至1.000；T4 - 6：AUC 1.000；p<0.0001；95%CI，1.000）。总之，本研究发现血清CysC是成人心脏手术后AKI的一种有用的早期生物标志物，且该标志物的程度与AKI的严重程度相关。
