Predictive value of cystatin C on acute kidney injury after total aortic arch replacement: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Jiaxin ¹ , FANG Miaoxian ¹ , LEI Liming ¹ , XIONG Weiping ¹ ,  CHEN Chunbo ^1,2,3

1. Department of Cardiac Surgical Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangzhou, 510080, P. R. China;
2. Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
3. Department of Critical Care Medicine, Maoming People's Hospital, Maoming, 525000, Guangdong, P. R. China;

Corresponding author：

CHEN Chunbo, Email: gghccm@163.com

Keywords：

Total aortic arch replacement; acute kidney injury; cystatin C

DOI：

10.7507/1007-4848.202103068

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Objective To explore the risk factors and predictive value of acute kidney injury (AKI) after total aortic arch replacement.Methods The clinical data of patients undergoing total aortic arch replacement in our hospital from January 2018 to June 2019 were retrospectively analyzed, and patients receiving preoperative renal replacement therapy and missing creatinine values were excluded. According to whether postoperative AKI occurred, patients were divided into an AKI group and a control group. The univariate and multivariate analyses (logistic regression) were used to explore the independent risk factors of AKI. The receiver operating characteristic curve was used to analyze the significant factors in predicting the occurrence of AKI after total aortic arch replacement.Results A total of 162 patients were included in the study, including 135 (83.3%) males and 27 (16.7%) females, with an average age of 52.61±9.90 years (range: 22 to 73 years). The incidence of AKI was 68.5% (n=111). The results of univariate and multivariate analyses showed that the postoperative serum cystatin C level (OR=76.145, 95%CI 15.575-372.260, P<0.01) was an independent risk factor for AKI after total aortic arch replacement. When its cut-off value was above 1.08 mg/L, the specificity for predicting postoperative AKI was 70.59%, and the sensitivity was 85.59%.Conclusion The postoperative cystatin C level is an independent risk factor for AKI after total aortic arch replacement and has predictive value.

Citation： LI Jiaxin, FANG Miaoxian, LEI Liming, XIONG Weiping, CHEN Chunbo. Predictive value of cystatin C on acute kidney injury after total aortic arch replacement: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1625-1630. doi: 10.7507/1007-4848.202103068 Copy

1.	Augoustides JG, Pochettino A, Ochroch EA, et al. Renal dysfunction after thoracic aortic surgery requiring deep hypothermic circulatory arrest: Definition, incidence, and clinical predictors. J Cardiothorac Vasc Anesth, 2006, 20(5): 673-677.
2.	Nakamura T, Mikamo A, Matsuno Y, et al. Impact of acute kidney injury on prognosis of chronic kidney disease after aortic arch surgery. Interact Cardiovasc Thorac Surg, 2020, 30(2): 273-279.
3.	Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
4.	Hu J, Chen R, Liu S, et al. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(1): 82-89.
5.	Ghincea CV, Reece TB, Eldeiry M, et al. Predictors of acute kidney injury following aortic arch surgery. J Surg Res, 2019, 242: 40-46.
6.	Mori Y, Sato N, Kobayashi Y, et al. Acute kidney injury during aortic arch surgery under deep hypothermic circulatory arrest. J Anesth, 2011, 25(6): 799-804.
7.	余金甜, 陈俊杉, 张爱琴. 急性 A 型主动脉夹层术后急性肾损伤危险因素的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2020, 27(1): 77-84.
8.	Nota H, Asai T, Suzuki T, et al. Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest. Interact Cardiovasc Thorac Surg, 2014, 19(6): 955-961.
9.	Medić B, Rovcanin B, Vujovic KS, et al. Evaluation of novel biomarkers of acute kidney injury: The possibilities and limitations. Curr Med Chem, 2016, 23(19): 1981-1997.
10.	Nejat M, Pickering JW, Walker RJ, et al. Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit. Nephrol Dial Transplant, 2010, 25(10): 3283-3289.
11.	Jung YJ, Lee HR, Kwon OJ. Comparison of serum cystatin C and creatinine as a marker for early detection of decreasing glomerular filtration rate in renal transplants. J Korean Surg Soc, 2012, 83(2): 69-74.
12.	Levey AS, Inker LA. Assessment of glomerular filtration rate in health and disease: A state of the art review. Clin Pharmacol Ther, 2017, 102(3): 405-419.
13.	Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol, 2019, 60(1): 3-11.
14.	Lassus JP, Nieminen MS, Peuhkurinen K, et al. Markers of renal function and acute kidney injury in acute heart failure: Definitions and impact on outcomes of the cardiorenal syndrome. Eur Heart J, 2010, 31(22): 2791-2798.
15.	Yin L, Li G, Liu T, et al. Probucol for the prevention of cystatin C-based contrast-induced acute kidney injury following primary or urgent angioplasty: A randomized, controlled trial. Int J Cardiol, 2013, 167(2): 426-429.
16.	Budano C, Andreis A, De Filippo O, et al. A single cystatin C determination before coronary angiography can predict short and long-term adverse events. Int J Cardiol, 2020, 300: 73-79.
17.	薛寅莹, 章淬, 牛永胜, 等. 尿 NGAL 对急性 Stanford A 型主动脉夹层手术后急性肾损伤的早期诊断价值. 中国胸心血管外科临床杂志, 2019, 26(11): 1103-1106.
18.	Basu RK, Wong HR, Krawczeski CD, et al. Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. J Am Coll Cardiol, 2014, 64(25): 2753-2762.
19.	池锐彬, 邓宇珺, 袁婕, 等. 尿 NAG 联合血清 CysC 预测重症患者急性肾损伤诊断和预后的临床价值. 中华急诊医学杂志, 2016, 25(2): 194-199.
20.	Wang L, Deng Y, Zhai Y, et al. Impact of blood glucose levels on the accuracy of urinary N-acety-β-D-glucosaminidase for acute kidney injury detection in critically ill adults: A multicenter, prospective, observational study. BMC Nephrol, 2019, 20(1): 186.

1. Augoustides JG, Pochettino A, Ochroch EA, et al. Renal dysfunction after thoracic aortic surgery requiring deep hypothermic circulatory arrest: Definition, incidence, and clinical predictors. J Cardiothorac Vasc Anesth, 2006, 20(5): 673-677.
2. Nakamura T, Mikamo A, Matsuno Y, et al. Impact of acute kidney injury on prognosis of chronic kidney disease after aortic arch surgery. Interact Cardiovasc Thorac Surg, 2020, 30(2): 273-279.
3. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract, 2012, 120(4): c179-c184.
4. Hu J, Chen R, Liu S, et al. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(1): 82-89.
5. Ghincea CV, Reece TB, Eldeiry M, et al. Predictors of acute kidney injury following aortic arch surgery. J Surg Res, 2019, 242: 40-46.
6. Mori Y, Sato N, Kobayashi Y, et al. Acute kidney injury during aortic arch surgery under deep hypothermic circulatory arrest. J Anesth, 2011, 25(6): 799-804.
7. 余金甜, 陈俊杉, 张爱琴. 急性 A 型主动脉夹层术后急性肾损伤危险因素的系统评价与 Meta 分析. 中国胸心血管外科临床杂志, 2020, 27(1): 77-84.
8. Nota H, Asai T, Suzuki T, et al. Risk factors for acute kidney injury in aortic arch surgery with selective cerebral perfusion and mild hypothermic lower body circulatory arrest. Interact Cardiovasc Thorac Surg, 2014, 19(6): 955-961.
9. Medić B, Rovcanin B, Vujovic KS, et al. Evaluation of novel biomarkers of acute kidney injury: The possibilities and limitations. Curr Med Chem, 2016, 23(19): 1981-1997.
10. Nejat M, Pickering JW, Walker RJ, et al. Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit. Nephrol Dial Transplant, 2010, 25(10): 3283-3289.
11. Jung YJ, Lee HR, Kwon OJ. Comparison of serum cystatin C and creatinine as a marker for early detection of decreasing glomerular filtration rate in renal transplants. J Korean Surg Soc, 2012, 83(2): 69-74.
12. Levey AS, Inker LA. Assessment of glomerular filtration rate in health and disease: A state of the art review. Clin Pharmacol Ther, 2017, 102(3): 405-419.
13. Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol, 2019, 60(1): 3-11.
14. Lassus JP, Nieminen MS, Peuhkurinen K, et al. Markers of renal function and acute kidney injury in acute heart failure: Definitions and impact on outcomes of the cardiorenal syndrome. Eur Heart J, 2010, 31(22): 2791-2798.
15. Yin L, Li G, Liu T, et al. Probucol for the prevention of cystatin C-based contrast-induced acute kidney injury following primary or urgent angioplasty: A randomized, controlled trial. Int J Cardiol, 2013, 167(2): 426-429.
16. Budano C, Andreis A, De Filippo O, et al. A single cystatin C determination before coronary angiography can predict short and long-term adverse events. Int J Cardiol, 2020, 300: 73-79.
17. 薛寅莹, 章淬, 牛永胜, 等. 尿 NGAL 对急性 Stanford A 型主动脉夹层手术后急性肾损伤的早期诊断价值. 中国胸心血管外科临床杂志, 2019, 26(11): 1103-1106.
18. Basu RK, Wong HR, Krawczeski CD, et al. Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. J Am Coll Cardiol, 2014, 64(25): 2753-2762.
19. 池锐彬, 邓宇珺, 袁婕, 等. 尿 NAG 联合血清 CysC 预测重症患者急性肾损伤诊断和预后的临床价值. 中华急诊医学杂志, 2016, 25(2): 194-199.
20. Wang L, Deng Y, Zhai Y, et al. Impact of blood glucose levels on the accuracy of urinary N-acety-β-D-glucosaminidase for acute kidney injury detection in critically ill adults: A multicenter, prospective, observational study. BMC Nephrol, 2019, 20(1): 186.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of cystatin C on acute kidney injury after total aortic arch replacement: A retrospective cohort study

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