Document Detail

Urinary biomarkers and renal near-infrared spectroscopy predict intensive care unit outcomes after cardiac surgery in infants younger than 6 months of age.
MedLine Citation:
PMID:  23317940     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the ability of urinary acute kidney injury biomarkers and renal near-infrared spectroscopy (NIRS) to predict outcomes in infants after surgery for congenital heart disease.
METHODS: Urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and cystatin C were measured preoperatively and postoperatively in 49 infants younger than 6 months of age. Renal NIRS was monitored for the first 24 hours after surgery. A composite poor outcome was defined as death, the need for renal replacement therapy, prolonged time to first extubation, or prolonged intensive care unit length of stay.
RESULTS: Forty-two (86%) patients had acute kidney injury as indicated by at least Acute Kidney Injury Network/Kidney Disease: Improving Global Outcomes (AKIN/KDIGO) stage 1 criteria, and 17 (35%) patients had poor outcomes, including 3 deaths. With the exception of KIM-1, all biomarkers demonstrated significant increases within 24 hours postoperatively among patients with poor outcomes. Low levels of NGAL and IL-18 demonstrated high negative predictive values (91%) within 2 hours postoperatively. Poor outcome infants had greater cumulative time with NIRS saturations less than 50% (60 vs 1.5 minutes; P = .02) in the first 24 hours.
CONCLUSIONS: Within the first 24 hours after cardiopulmonary bypass, infants at increased risk for poor outcomes demonstrated elevated urinary NGAL, IL-18, and cystatin C and increased time with low NIRS saturations. These findings suggest that urinary biomarkers and renal NIRS may differentiate patients with good versus poor outcomes in the early postoperative period, which could assist clinicians when counseling families and inform the development of future clinical trials.
Matthew A Hazle; Robert J Gajarski; Ranjit Aiyagari; Sunkyung Yu; Abin Abraham; Janet Donohue; Neal B Blatt
Publication Detail:
Type:  Journal Article     Date:  2013-01-12
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  146     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-09-17     Completed Date:  2013-11-08     Revised Date:  2014-10-18    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  861-867.e1     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Acute Kidney Injury / blood,  diagnosis*,  etiology,  mortality,  therapy,  urine
Acute-Phase Proteins / urine*
Age Factors
Biological Markers / blood,  urine
Cardiac Surgical Procedures / adverse effects*,  mortality
Cardiopulmonary Bypass / adverse effects
Cystatin C / urine*
Heart Defects, Congenital / blood,  mortality,  surgery*,  urine
Infant, Newborn
Intensive Care Units, Neonatal
Intensive Care Units, Pediatric*
Interleukin-18 / urine*
Length of Stay
Lipocalins / urine*
Logistic Models
Membrane Glycoproteins / urine
Oxyhemoglobins / metabolism*
Predictive Value of Tests
Prospective Studies
Proto-Oncogene Proteins / urine*
Receptors, Virus
Renal Replacement Therapy
Risk Factors
Spectroscopy, Near-Infrared*
Time Factors
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Acute-Phase Proteins; 0/Biological Markers; 0/CST3 protein, human; 0/Cystatin C; 0/HAVCR1 protein, human; 0/Interleukin-18; 0/LCN2 protein, human; 0/Lipocalins; 0/Membrane Glycoproteins; 0/Oxyhemoglobins; 0/Proto-Oncogene Proteins; 0/Receptors, Virus

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