Urinary cystatin C as an early biomarker of acute kidney injury after open and endovascular abdominal aortic aneurysm repair

Επιστημονική δημοσίευση - Άρθρο Περιοδικού uoadl:3126836 7 Αναγνώσεις

Μονάδα:
Ερευνητικό υλικό ΕΚΠΑ
Τίτλος:
Urinary cystatin C as an early biomarker of acute kidney injury after open and endovascular abdominal aortic aneurysm repair
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background Acute kidney injury (AKI) after open repair (OR) and endovascular repair (EVAR) of abdominal aortic aneurysm (AAA) is associated with increased mortality and hospital costs. Early detection of AKI is critical to prevent its progression. Recent findings demonstrate that elevated levels of urinary cystatin C (uCysC) may reflect tubular dysfunction. We prospectively evaluated whether uCysC can detect renal dysfunction earlier than serum creatinine (sCr).
Methods In a prospective study, 126 consecutive patients (mean age ± SD, 69.1 ± 8.66 years) with AAA (EVAR = 87, OR = 39) were enrolled. sCr and uCysC were measured preoperatively (baseline) and at 6, 24, and 48 hr postoperatively. A final measurement was made on day 5. AKI was defined according to Acute Kidney Injury Network criteria.
Results The incidence of AKI was significantly higher (χ2 test, P < 0.05) in the OR group (n = 13, 33%) than in the EVAR group (n = 15, 17%). The baseline median (interquartile range) value of uCysC was significantly higher (t-test, P < 0.05) in patients of both groups (OR-EVAR) who developed AKI from those who did not (OR/AKI group: 0.06 [0.02-0.12] mg/L, EVAR/AKI group: 0.08 [0.05-0.11] mg/L versus no-AKI subjects: 0.04 [0.02-0.07] mg/L). Subsequent analysis showed that at 6 hr postoperatively, the patients who developed AKI increased their uCysC levels significantly from baseline (OR/AKI group: 0.58 [0.42-0.70] mg/L, EVAR/AKI group: 0.59 [0.30-1.07] mg/L). The median value of uCysC in AKI patients increased at 24 hr (OR/AKI group: 1.37 [0.78-3.40] mg/L, EVAR/AKI group: 2.11 [0.70-2.42] mg/L) and peaked at 48 hr (OR/AKI group: 6.16 [1.74-10.73] mg/L, EVAR/AKI group: 2.57 [1.21-7.40] mg/L), while no increase was observed among those who did not develop AKI at the same time points (0.06 [0.04-0.14] vs. 0.08 [0.04-0.19] mg/L). The diagnostic accuracy of uCysC at 6 hr post-surgery was excellent (area under the curve - receiver-operating characteristic [AUC-ROC] = 0.968), significantly higher than sCr (AUC-ROC = 0.844) and a cutoff value set at 0.30 mg/L can diagnose AKI with a sensitivity of 85.71% and a specificity of 98.97%.
Conclusions uCysC is superior to sCr in the early diagnosis of AKI following open and endovascular AAA repair. © 2014 Elsevier Inc. All rights reserved.
Έτος δημοσίευσης:
2014
Συγγραφείς:
Pirgakis, K.M.
Makris, K.
Dalainas, I.
Lazaris, A.M.
Maltezos, C.K.
Liapis, C.D.
Περιοδικό:
Annals of Vascular Surgery
Εκδότης:
HANLEY & BELFUS-ELSEVIER INC
Τόμος:
28
Αριθμός / τεύχος:
7
Σελίδες:
1649-1658
Λέξεις-κλειδιά:
biological marker; creatinine; cystatin C; biological marker; cystatin C, abdominal aorta aneurysm; acute kidney failure; aged; Article; creatinine blood level; diagnostic accuracy; diagnostic test accuracy study; early diagnosis; endovascular aneurysm repair; female; human; incidence; kidney dysfunction; laboratory test; major clinical study; male; measurement; outcome assessment; prospective study; protein urine level; risk assessment; sensitivity and specificity; acute kidney failure; Aortic Aneurysm, Abdominal; comorbidity; endovascular surgery; postoperative complication; risk factor; treatment outcome; urine; vascular surgery, Acute Kidney Injury; Aged; Aortic Aneurysm, Abdominal; Biological Markers; Comorbidity; Cystatin C; Endovascular Procedures; Female; Humans; Male; Postoperative Complications; Prospective Studies; Risk Factors; Treatment Outcome; Vascular Surgical Procedures
Επίσημο URL (Εκδότης):
DOI:
10.1016/j.avsg.2014.04.006
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