Acute kidney injury (AKI) is associated with mortality after cardiac surgery. Novel risk factors may improve identification of patients at risk for renal injury. The authors evaluated the association between preoperative biomarkers that reflect cardiac, inflammatory, renal, and metabolic disorders and cardiac surgery–associated AKI (CSA-AKI) in elderly patients.
METHODS:
This was a secondary analysis of the 2-center prospective cohort study “Anesthesia Geriatric Evaluation.” Twelve biomarkers were determined preoperatively in 539 patients. Primary outcome was CSA-AKI. The association between biomarkers and CSA-AKI was investigated with multivariable logistic regression analysis. Secondary outcomes were 1-year mortality and patient-reported disability and were assessed with relative risks (RR) between patients with and without CSA-AKI.
RESULTS:
CSA-AKI occurred in 88 (16.3%) patients and was associated with increased risk of mortality (RR, 6.70 [95% confidence interval {CI}, 3.38–13.30]) and disability (RR, 2.13 [95% CI, 1.53–2.95]). Preoperative concentrations of N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), hemoglobin, and magnesium had the strongest association with CSA-AKI. Identification of patients with CSA-AKI improved when a biomarker panel was used (area under the curve [AUC] 0.75 [95% CI, 0.69–0.80]) compared to when only clinical risk factors were used (European System for Cardiac Operative Risk Evaluation [EuroSCORE II] AUC 0.67 [95% CI, 0.62–0.73]).
CONCLUSIONS:
Preoperative cardiac, inflammatory, renal, and metabolic biomarkers are associated with CSA-AKI and may improve identification of patients at risk.
KEY POINTS
- Question: Are preoperative cardiac, inflammatory, renal, and metabolic biomarkers associated with cardiac surgery–associated acute kidney injury (CSA-AKI) in elderly patients?
- Finding: Preoperative N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP), hemoglobin, and magnesium concentrations are associated with CSA-AKI and could improve risk stratification.
- Meaning: A panel with cardiac, inflammatory, renal, and metabolic biomarkers can be used to better identify older patients at risk for renal injury after cardiac surgery.
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