A postoperative biomarker combination of H-FABP, midkine, and sTNFR2 accurately predicted the risk of developing acute kidney injury following cardiac surgery (AUROC 0.836).
Observational (n=344)
No
Does a combination of biomarkers and clinical factors pre and post cardiac surgery accurately stratify patients at risk of developing acute kidney injury?
A novel algorithm combining clinical risk factors with preoperative and postoperative biomarkers (sTNFR1/2, H-FABP, midkine) can accurately stratify the risk of acute kidney injury in patients undergoing elective cardiac surgery.
Effect estimate: AUROC 0.836 (95% CI 0.785-0.888)
Acute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risks. Improving existing clinical methods of identifying patients at risk of perioperative AKI may advance management and treatment options. This study investigated whether a combination of biomarkers and clinical factors pre and post cardiac surgery could stratify patients at risk of developing AKI. Patients (n = 401) consecutively scheduled for elective cardiac surgery were prospectively studied. Clinical data was recorded and blood samples were tested for 31 biomarkers. Areas under receiver operating characteristic (AUROCs) were generated for biomarkers pre and postoperatively to stratify patients at risk of AKI. Preoperatively sTNFR1 had the highest predictive ability to identify risk of developing AKI postoperatively (AUROC 0.748). Postoperatively a combination of H-FABP, midkine and sTNFR2 had the highest predictive ability to identify AKI risk (AUROC 0.836). Preoperative clinical risk factors included patient age, body mass index and diabetes. Perioperative factors included cardio pulmonary bypass, cross-clamp and operation times, intra-aortic balloon pump, blood products and resternotomy. Combining biomarker risk score (BRS) with clinical risk score (CRS) enabled pre and postoperative assignment of patients to AKI risk categories. Combining BRS with CRS will allow better management of cardiac patients at risk of developing AKI.
McBride et al. (Mon,) conducted a observational in Acute kidney injury following cardiac surgery (n=344). Biomarker-based algorithm (H-FABP, midkine, sTNFR2) and clinical risk score vs. Standard clinical assessment was evaluated on Prediction of acute kidney injury (eGFR drop ≥ 25% from baseline) (AUROC 0.836, 95% CI 0.785-0.888). A postoperative biomarker combination of H-FABP, midkine, and sTNFR2 accurately predicted the risk of developing acute kidney injury following cardiac surgery (AUROC 0.836).