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27-09-2024 | Heart Surgery | Original Article

Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery

Authors: Kevin A. Pettit, Katherine F. Melink, Jeffrey A. Alten, Stuart L. Goldstein, Nicholas Ollberding, Megan SooHoo, Emily Sullivan, Huaiyu Zang, Natalja L. Stanski, Katja M. Gist

Published in: Pediatric Nephrology

Abstract

Background

Pediatric cardiac surgery-associated acute kidney injury (CS-AKI) is common with variable association with outcomes, possibly because transient serum creatinine (SCr) elevations are unrelated to kidney disease. Sub-phenotypes of CS-AKI with biomarker integration may provide prognostic enrichment. This study aims to determine if combining early postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr into sub-phenotypes strengthens associations with AKI and outcomes. We hypothesized that patients with early subclinical (uNGAL + , SCr −) or damage (uNGAL + , SCr +) CS-AKI would have more postoperative day 2–4 KDIGO-defined AKI and worse clinical outcomes than patients with early functional AKI (uNGAL − , SCr +).

Methods

Two-center prospective observational study evaluating combinations of early uNGAL (8–12 h from ICU admission, ≥ 150 ng/mL) and early postoperative (≤ 8 h of admission) KDIGO SCr-defined AKI to predict CS-AKI on postoperative days (POD) 2–4. Four CS-AKI phenotypes were derived (uNGAL − /SCr − ; uNGAL + /SCr − ; uNGAL − /SCr + and uNGAL + /SCr +). The primary outcome was POD2–4 KDIGO SCr-defined CS-AKI. Secondary outcomes included ventilator and intensive care unit-free days (maximum 28).

Results

Four hundred seventy-six patients (median age 4.8 [IQR 1.4–30.4] months, 39% female) were included. POD2–4 AKI occurred in 44 (9.2%). 27% were uNGAL + /SCr − and 0.4% (n = 2) uNGAL + /SCr + . The adjusted odds of POD2–4 AKI was ninefold higher (aOR: 9.09, 95%CI: 3.84–21.53) in uNGAL + /SCr − when compared to uNGAL − /SCr − . uNGAL + /SCr − was associated with fewer ventilator-free (aOR: 0.30, 95%CI: 0.19–0.48) and ICU-free days (aOR: 0.41, 95%CI: 0.26–0.66) when compared to uNGAL − /SCr − .

Conclusion

Early postoperative uNGAL, regardless of SCr elevation, refines risk assessment for pediatric POD2–4 CS-AKI and associated morbidity, enabling earlier AKI identification and prognostics.

Graphical Abstract

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Title: Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery
Authors: Kevin A. Pettit
Katherine F. Melink
Jeffrey A. Alten
Stuart L. Goldstein
Nicholas Ollberding
Megan SooHoo
Emily Sullivan
Huaiyu Zang
Natalja L. Stanski
Katja M. Gist
Publication date: 27-09-2024
Publisher: Springer Berlin Heidelberg
Keywords: Heart Surgery
Heart Surgery
Acute Kidney Injury
Acute Kidney Injury
Biomarkers
Published in: Pediatric Nephrology
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-024-06541-z

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Graphical Abstract

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