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

Publication ,  Journal Article
Parikh, CR; Coca, SG; Thiessen-Philbrook, H; Shlipak, MG; Koyner, JL; Wang, Z; Edelstein, CL; Devarajan, P; Patel, UD; Zappitelli, M; Garg, AX ...
Published in: J Am Soc Nephrol
September 2011

Acute kidney injury (AKI) is a frequent complication of cardiac surgery and increases morbidity and mortality. The identification of reliable biomarkers that allow earlier diagnosis of AKI in the postoperative period may increase the success of therapeutic interventions. Here, we conducted a prospective, multicenter cohort study involving 1219 adults undergoing cardiac surgery to evaluate whether early postoperative measures of urine IL-18, urine neutrophil gelatinase-associated lipocalin (NGAL), or plasma NGAL could identify which patients would develop AKI and other adverse patient outcomes. Urine IL-18 and urine and plasma NGAL levels peaked within 6 hours after surgery. After multivariable adjustment, the highest quintiles of urine IL-18 and plasma NGAL associated with 6.8-fold and 5-fold higher odds of AKI, respectively, compared with the lowest quintiles. Elevated urine IL-18 and urine and plasma NGAL levels associated with longer length of hospital stay, longer intensive care unit stay, and higher risk for dialysis or death. The clinical prediction model for AKI had an area under the receiver-operating characteristic curve (AUC) of 0.69. Urine IL-18 and plasma NGAL significantly improved the AUC to 0.76 and 0.75, respectively. Urine IL-18 and plasma NGAL significantly improved risk prediction over the clinical models alone as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In conclusion, urine IL-18, urine NGAL, and plasma NGAL associate with subsequent AKI and poor outcomes among adults undergoing cardiac surgery.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

September 2011

Volume

22

Issue

9

Start / End Page

1748 / 1757

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Proto-Oncogene Proteins
  • Prospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Male
  • Lipocalins
  • Lipocalin-2
  • Interleukin-18
  • Humans
 

Citation

APA
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ICMJE
MLA
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Parikh, C. R., Coca, S. G., Thiessen-Philbrook, H., Shlipak, M. G., Koyner, J. L., Wang, Z., … TRIBE-AKI Consortium, . (2011). Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol, 22(9), 1748–1757. https://doi.org/10.1681/ASN.2010121302
Parikh, Chirag R., Steven G. Coca, Heather Thiessen-Philbrook, Michael G. Shlipak, Jay L. Koyner, Zhu Wang, Charles L. Edelstein, et al. “Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery.J Am Soc Nephrol 22, no. 9 (September 2011): 1748–57. https://doi.org/10.1681/ASN.2010121302.
Parikh CR, Coca SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Wang Z, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol. 2011 Sep;22(9):1748–57.
Parikh, Chirag R., et al. “Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery.J Am Soc Nephrol, vol. 22, no. 9, Sept. 2011, pp. 1748–57. Pubmed, doi:10.1681/ASN.2010121302.
Parikh CR, Coca SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Wang Z, Edelstein CL, Devarajan P, Patel UD, Zappitelli M, Krawczeski CD, Passik CS, Swaminathan M, Garg AX, TRIBE-AKI Consortium. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol. 2011 Sep;22(9):1748–1757.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

September 2011

Volume

22

Issue

9

Start / End Page

1748 / 1757

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Proto-Oncogene Proteins
  • Prospective Studies
  • Predictive Value of Tests
  • Postoperative Complications
  • Male
  • Lipocalins
  • Lipocalin-2
  • Interleukin-18
  • Humans