Neutrophil Extracellular Traps and Acute Kidney Injury in Pediatric Patients Receiving Cardiopulmonary Bypass

Objectives: To assess whether preoperative plasma neutrophil extracellular traps (NETs) are associated with acute kidney injury (AKI), CICU length of stay, duration of hospital length of stay, chylothorax, thrombus, necrotizing enterocolitis (NEC), and vasoactive-ventilator-renal (VVR) score in pediatric patients undergoing cardiopulmonary bypass (CPB). Design: Single-center, prospective observational cohort study. Setting: Tertiary academic pediatric hospital. Patients: A total of 118 pediatric patients (birth to < 18 yr) undergoing CPB between June 2022 and June 2024. Intervention: None. Measurements and Main Results: Preoperative plasma NET levels were quantified by measuring myeloperoxidase-DNA complex levels via enzyme-linked immunosorbent assay. AKI was defined using the Kidney Disease Improving Global Outcomes serum creatinine or urine output criteria. Creatinine was corrected for fluid balance on each postoperative day. AKI occurred in 31% of patients. Higher preoperative NET levels occurred more frequently among patients with postoperative AKI and lower Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery score 1–3 patients. A 1 sd increase in NET levels was also significantly associated with a 2.61-fold increase in odds of NEC in unadjusted logistic regression (OR, 2.61 [95% CI, 1.29–5.31]). No associations were observed with CICU length of stay, hospital length of stay, chylothorax, thrombosis, or VVR score. Conclusions: Elevated preoperative plasma NET levels may serve as a biomarker of early postoperative complications, including AKI and NEC, in pediatric CPB. Further studies are needed to validate these findings and explore targeted therapies.