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Acute kidney injury induces high-sensitivity troponin measurement changes after cardiac surgery
Amr S Omar1,2,3, Khaled Mahmoud4,5,6, Samy Hanoura7,4,8
1Department of Cardiothoracic Surgery/Cardiac Anaesthesia and ICU, Heart Hospital, Hamad Medical Corporation, Doha, PO 3050, Qatar. a_s_omar@yahoo.com.
Insights
High-sensitivity troponin T (hsTnT) shows sustained changes in patients with acute kidney injury (AKI) after cardiac surgery, unlike CK-MB. This suggests hsTnT may have delayed clearance in AKI, impacting cardiac risk assessment.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Cardiac troponin's utility for cardiac disease risk assessment differs in end-stage renal disease (ESRD) and is understudied in acute kidney injury (AKI).
- Cardiac surgery is a common cause of AKI, necessitating evaluation of cardiac biomarkers in this context.
Purpose of the Study:
- To explore the diagnostic value of high-sensitivity troponin T (hsTnT) in patients experiencing cardiac surgery-induced AKI.
- To compare the behavior of hsTnT and creatine kinase-MB (CK-MB) in patients with and without AKI post-cardiac surgery.
Main Methods:
- A single-center, observational, retrospective study included 359 patients undergoing cardiac surgery, divided into non-AKI (259 patients) and AKI (100 patients) groups based on AKI Network criteria.
- Serial measurements of hsTnT and CK-MB were performed. Patients with ESRD were excluded.
Main Results:
- The AKI group exhibited significantly higher mortality (5% vs. 1.1%), increased incidence of heart failure (17.9% vs. 4.9%), and post-operative atrial fibrillation (12.4% vs. 2.9%).
- hsTnT showed a significant sustained rise in the AKI group compared to the non-AKI group, whereas CK-MB changes were significant initially but not sustained.
- Patients with AKI had longer ventilation durations and hospital stays.
Conclusions:
- hsTnT demonstrates significant, sustained changes throughout the observation period in patients with AKI post-cardiac surgery.
- These findings suggest a possible delayed clearance of hsTnT in AKI patients, differentiating its behavior from CK-MB and impacting its interpretation as a cardiac risk assessment tool.
Background:
The value of cardiac troponin as a risk assessment tool for cardiac disease in the setting of end-stage renal diseases (ESRD) is not equivalent to its value in those with normal renal function. This consideration had not been studied in settings of acute kidney injury (AKI). We aim to explore the diagnostic value of high sensitive troponin T (hsTnT) in the settings of cardiac surgery-induced AKI.
Methods:
Single center observational retrospective study. Based on the AKI Network, patients divided into 2 groups, group I without AKI (259 patients) and group II with AKI (100 patients) where serial testing of hsTnT and creatine kinase (CK)-MB were followed in both groups. Patients with (ESRD) were excluded.
Results:
The mean age in our study was 55.1 ± 10.2 years. High association of AKI (27.8%) was found in our patients. Both groups were matched regarding the age, gender, body mass index, the association of diabetes or hypertension, and Euro score. AKI group had significantly higher mortality 5% vs group I 1.1% (p = 0.03). The hsTnt showed a significant sustained rise in the AKI group as compared to the non-AKI group, however CK-MB changes were significant initially but not sustained. The AKI group was more associated with heart failure 17.9% vs 4.9% (p = 0.001); and post-operative atrial fibrillation, 12.4% vs 2.9% (p = 0.005). Lengths of ventilation, stays in ICU and in hospital were significantly higher in the AKI group.
Conclusions:
Unlike the CK-MB profile, the hsTnT showed significant changes between both groups all over the course denoting possible delayed clearance in patients with AKI.
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