Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery

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Chirag R Parikh1, Prasad Devarajan, Michael Zappitelli

  • 1Section of Nephrology, Yale University and VAMC, 950 Campbell Avenue, Mail Code 151B, West Haven, CT 06516, USA. chirag.parikh@yale.edu

Journal of the American Society of Nephrology : JASN
|August 13, 2011
PubMed

Insights

Early detection of acute kidney injury (AKI) in children after heart surgery is possible using urine biomarkers. Urine IL-18 and urine neutrophil gelatinase-associated lipocalin (NGAL) can predict AKI and other adverse outcomes.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Surgery
  • Biomarker Discovery

Background:

  • Acute kidney injury (AKI) is a common and serious complication following pediatric cardiac surgery.
  • Early identification of AKI is crucial for timely intervention and improved patient outcomes.
  • Existing biomarkers for AKI prediction in this population have limitations.

Purpose of the Study:

  • To evaluate the utility of early postoperative urine IL-18 and urine/plasma neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI and adverse outcomes in children undergoing cardiac surgery.
  • To assess the diagnostic accuracy and prognostic value of these biomarkers.
  • To determine if these biomarkers improve risk prediction models.

Main Methods:

  • Prospective, multicenter cohort study of 311 children undergoing surgery for congenital cardiac lesions.
  • Measurement of urine IL-18, urine NGAL, and plasma NGAL levels within 6 hours post-surgery.
  • Correlation of biomarker levels with the incidence of severe AKI (dialysis or doubled serum creatinine) and other clinical outcomes.

Main Results:

  • Urine IL-18 and urine NGAL levels were significantly associated with severe AKI.
  • The highest quintiles of urine IL-18 and urine NGAL showed substantially increased odds of AKI (6.9-fold and 4.1-fold, respectively).
  • Elevated urine biomarkers also correlated with longer hospital stays, ICU stays, and mechanical ventilation duration.
  • Diagnostic accuracy for severe AKI was moderate (AUC 0.72 for urine IL-18, 0.71 for urine NGAL).
  • Inclusion of these biomarkers improved risk prediction beyond clinical models.

Conclusions:

  • Urine IL-18 and urine NGAL are promising biomarkers for early prediction of AKI and adverse outcomes in pediatric cardiac surgery patients.
  • Plasma NGAL did not show a significant association with AKI in this cohort.
  • These urine biomarkers enhance the accuracy of risk stratification for AKI in this vulnerable population.

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