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Preoperative risk assessment improves biomarker detection for predicting acute kidney injury after cardiac surgery
- Source :
- PLoS ONE, Vol 13, Iss 9, p e0203447 (2018)
- Publication Year :
- 2018
-
Abstract
- Background Although urinary neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a promising biomarker for the early detection of kidney injury, previous studies of adult patients who underwent cardiac surgery have reported only moderate discrimination. The age, creatinine, and ejection fraction (ACEF) score is a preoperative validated risk model with satisfactory accuracy for predicting AKI following cardiac surgery. It remains unknown whether combining preoperative risk assessment through ACEF scores followed by urinary NGAL test in a population of high-risk individuals is an optimal approach with improved predictive performance. Material and methods A total of 177 consecutive patients who underwent cardiac surgery were enrolled. Clinical characteristics, prognostic model scores, and outcomes were assessed. Urinary NGAL were examined within 6 hours after cardiac surgery. Patients were stratified according to preoperative ACEF scores, and comparisons were made using the area under the receiver operator characteristic curve (AUROC) for the prediction of AKI. Results A total of 45.8% (81/177) of the patients had AKI. As expected, patients with ACEF scores ≥ 1.1 were older and more likely to have class III or IV heart failure. They were also more likely to have diabetes mellitus, myocardial infarction, and peripheral arterial disease. Urinary NGAL alone moderately predicted AKI, with an AUROC of 0.732. Risk stratification by ACEF scores ≥ 1.1 substantially improved the AUROC of urinary NGAL to 0.873 (95% confidence interval, 0.784–0.961; P < .001). Conclusions Risk stratification by preoperative ACEF scores ≥ 1.1, followed by postoperative urinary NGAL, provides more satisfactory risk discrimination than does urinary NGAL alone for the early detection of AKI after cardiac surgery. Future studies should investigate whether this strategy could improve the outcomes and cost-effectiveness of care in patients undergoing cardiac surgery.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
Urinary system
Population
030232 urology & nephrology
lcsh:Medicine
030204 cardiovascular system & hematology
Risk Assessment
03 medical and health sciences
0302 clinical medicine
Postoperative Complications
Lipocalin-2
Internal medicine
Preoperative Care
medicine
Humans
Myocardial infarction
Cardiac Surgical Procedures
education
lcsh:Science
Aged
education.field_of_study
Multidisciplinary
Ejection fraction
business.industry
lcsh:R
Acute kidney injury
Models, Cardiovascular
Stroke Volume
Acute Kidney Injury
Middle Aged
medicine.disease
Cardiac surgery
Heart failure
Cardiology
Biomarker (medicine)
lcsh:Q
Female
business
Biomarkers
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 13
- Issue :
- 9
- Database :
- OpenAIRE
- Journal :
- PloS one
- Accession number :
- edsair.doi.dedup.....48cf3a5c65a0fdcb9ef7d3853570cd68