Early postoperative serum cystatin C predicts severe acute kidney injury following cardiac surgery : a post-hoc analysis of a randomized controlled trial

  • Objective: Acute kidney injury (AKI) after cardiac surgery procedures is associated with poor patient outcomes. Cystatin C as a marker for renal failure has been shown to be of prognostic value; however, a wide range of its predictive accuracy has been reported. The aim of the study was to evaluate whether the measurement of pre- and postoperative serum cystatin C improves the prediction of AKI. Methods: In a single-centre, prospective study of 70 patients (74 ± 9ys; range 47-85ys; 77% male), cystatin C was measured six times: (T1 = preoperative, T2 = start cardiopulmonary bypass (CPB), T3 = 20 min after CPB, T4 = end of operation; T5 = 24 h postoperatively; T6 = 7d postoperatively). Predictive property, in terms of the need for renal replacement therapy (RRT), was analysed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC). Results: With respect to RRT (n = 8), serum cystatin C was significantly higher at the end of the operation (T4), 24 h postoperatively at T5 and at T6. The AUCs for preoperative T1 and intraoperative T2/3 cystatin C were <0.7 (95% CI, 0.47-0.85). The earliest significant predictive AUCs were found at the end of the operation (T4: p = 0.03 95% CI 0.58-0.88 AUC 0.73) and 24 h postoperatively (T5: p = 0.003 95% CI 0.74-0.96 AUC 0.85). Conclusions: Early postoperative serum cystatin C increase appears to be a moderate biomarker in the prediction of AKI, whereas a preoperative and intraoperative cystatin C increase has only a limited diagnostic and predictive value.

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Author:Arndt-Holger KiesslingORCiDGND, Juliane DietzORCiDGND, Christian Reyher, Ulrich Alfred StockORCiDGND, Andrés Beiras FernándezGND, Anton Moritz
Pubmed Id:https://pubmed.ncbi.nlm.nih.gov/24397879
Parent Title (English):Journal of cardiothoracic surgery
Publisher:BioMed Central
Place of publication:London
Document Type:Article
Date of Publication (online):2014/01/08
Date of first Publication:2014/01/08
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2014/01/31
Page Number:7
First Page:1
Last Page:7
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Institutes:Medizin / Medizin
Dewey Decimal Classification:5 Naturwissenschaften und Mathematik / 51 Mathematik / 510 Mathematik
Licence (German):License LogoCreative Commons - Namensnennung 2.0