Association of Cardiac Biomarkers with Acute Kidney Injury after Cardiac Surgery: A Multicenter Cohort Study

Abstract Background Acute kidney injury (AKI) is common after cardiac surgery and is associated with post-operative mortality. Perioperative cardiac biomarkers may predict AKI and mortality. Objective We evaluated whether cardiac biomarkers were associated with severe AKI, defined as a doubling in s...

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Published in:	The Journal of thoracic and cardiovascular surgery 2016-07, Vol.152 (1), p.245-251.e4
Main Authors:	Belley-Cote, Emilie P., MD, Parikh, Chirag R., MD, PhD, Shortt, Colleen R, Coca, Steven G., DO, MS, Garg, Amit X., MD, PhD, MA, FACP, Eikelboom, John W., MD, MBBS, Kavsak, Peter, PhD, McArthur, Eric, MSc, Thiessen-Philbrook, Heather, MMath, AStat, Whitlock, Richard P., MD, PhD
Format:	Article
Language:	eng
Subjects:	acute kidney injury Acute Kidney Injury - blood Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Aged biomarkers Biomarkers - blood brain natriuretic peptide cardiac surgery Cardiac Surgical Procedures - adverse effects Cardiothoracic Surgery Creatine Kinase, MB Form - blood Female Follow-Up Studies Heart Diseases - surgery Humans Incidence Male mortality Natriuretic Peptide, Brain - blood Ontario - epidemiology Peptide Fragments - blood Postoperative Complications Prospective Studies troponin Troponin I - blood Troponin T - blood United States - epidemiology
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Summary:	Abstract Background Acute kidney injury (AKI) is common after cardiac surgery and is associated with post-operative mortality. Perioperative cardiac biomarkers may predict AKI and mortality. Objective We evaluated whether cardiac biomarkers were associated with severe AKI, defined as a doubling in serum creatinine or requiring renal replacement therapy during hospital stay after surgery, and mortality. Methods In a prospective multicenter cohort of adults undergoing cardiac surgery, we measured the following biomarkers in pre- and post-operative banked plasma: high-sensitivity troponin T (hs-cTnT), troponin I (cTnI), CK-MB and NT-proBNP. Results In the patients who were discharged alive, severe AKI occurred in 37/960 (3.9%) and 43/960 (4.5%) died within 1 year of follow-up. NT-proBNP was the only pre-operative biomarker that was independently associated with severe AKI (with log transformation, adjusted OR=1.4, 95% CI (1.0, 1.9)). Biomarkers measured within 6 hours of surgery (Day 1) were all associated with severe AKI. Pre-operative NT-proBNP was also independently associated with 1-year mortality (with log transformation, adjusted OR=1.7, 95% CI (1.2-2.2)). Patients in the highest tertile for NT-proBNP pre-operatively (>1006.4 ng/L) had marked increases in their risk for 1-year mortality (adjusted OR=27.2, 95%CI (3.5-213.5)). Day 1 NT-proBNP was associated with mortality independently of change in serum creatinine from pre-operative baseline. Conclusion Of the studied biomarkers, NT-proBNP was the only pre-operative biomarker independently associated with severe AKI and mortality. Early increases in post-operative cardiac biomarkers were associated with severe AKI after cardiac surgery. Future research should focus on whether interventions that lower NT-proBNP can impact upon post-operative outcomes.
ISSN:	0022-5223 1097-685X