Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery
Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery
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DOI：
10.1016/j.jtcvs.2016.03.079
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发表时间：
2016-07-01
影响因子：
6
通讯作者：
Liborio, Alexandre Braga
中科院分区：
文献类型：
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作者：
de Melo Bezerra Cavalcante, Candice Torres;Castelo Branco, Klebia Magalhaes;Liborio, Alexandre Braga
目的：急性肾损伤是小儿心脏手术后常见的情况，与不良的患者预后相关。 Syndecan-1 是内皮糖萼损伤的生物标志物，其术后早期增加可能与急性肾损伤相关。 方法：我们对 289 名在 1 个参考机构接受心脏手术的 18 岁以下患者进行了一项前瞻性队列研究。心脏手术后最初 2 小时内收集术后血浆 syndecan-1。严重急性肾损伤（根据肾脏疾病：改善全球结果第 2 或第 3 阶段定义）、血清肌酐较术前值翻倍或住院期间需要透析是主要结局。根据临床变量和“肾性心绞痛指数”成分（估计肌酐清除率较基线早期下降以及术后第一天重症监护病房液体超负荷百分比增加）对分析进行了调整。结果：术后早期测量的血浆 syndecan-1 水平与严重急性肾损伤独立相关。术后 Syndecan-1 诊断严重急性肾损伤的准确性为中等（接受者操作特征曲线下面积，0.77；95% 置信区间，0.68-0.85）。添加 syndecan-1 将临床模型的辨别能力从 0.80 提高到 0.86 (P = .004)，并改善了风险预测（通过净重分类改进和综合辨别改进来衡量）。术后 sundecan-1 水平也与延长重症监护室时间和住院时间独立相关。结论：术后血浆 syndecan-1 与接受心脏手术的儿童随后的严重急性肾损伤和不良结局相关。识别心脏手术后急性肾损伤风险增加的患者可能有用。
Objective: Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury.Methods: We performed a prospective cohort study with 289 patients aged less than 18 years who underwent cardiac surgery at 1 reference institution. Postoperative plasma syndecan-1 was collected within the first 2 hours after cardiac surgery. Severe acute kidney injury, defined according to Kidney Disease: Improving Global Outcomes stage 2 or 3, doubling of serum creatinine from the preoperative value, or need for dialysis during hospitalization, was the main outcome. Analyses were adjusted for clinical variables and "renal angina index" components (early decrease in estimated creatinine clearance from baseline and increase in percent of intensive care unit fluid overload on the first postoperative day).Results: Plasma syndecan-1 levels measured early in the postoperative period were independently associated with severe acute kidney injury. The accuracy of postoperative syndecan-1 for the diagnosis of severe acute kidney injury was moderate (area under the curve receiver operating characteristic, 0.77; 95% confidence interval, 0.68-0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (P = .004) and improved risk prediction, as measured by net reclassification improvement and integrated discrimination improvement. Postoperative sundecan-1 levels also were independently associated with longer length of intensive care unit and hospital stay.Conclusions: Postoperative plasma syndecan-1 is associated with subsequent severe acute kidney injury and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for acute kidney injury after cardiac surgery.