OBJECTIVE: To assess the ability of urinary acute kidney injury biomarkers and renal near-infrared spectroscopy (NIRS) to predict outcomes in infants after surgery for congenital heart disease. METHODS: Urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and cystatin C were measured preoperatively and postoperatively in 49 infants younger than 6 months of age. Renal NIRS was monitored for the first 24 hours after surgery. A composite poor outcome was defined as death, the need for renal replacement therapy, prolonged time to first extubation, or prolonged intensive care unit length of stay. RESULTS: Forty-two (86%) patients had acute kidney injury as indicated by at least Acute Kidney Injury Network/Kidney Disease: Improving Global Outcomes (AKIN/KDIGO) stage 1 criteria, and 17 (35%) patients had poor outcomes, including 3 deaths. With the exception of KIM-1, all biomarkers demonstrated significant increases within 24 hours postoperatively among patients with poor outcomes. Low levels of NGAL and IL-18 demonstrated high negative predictive values (91%) within 2 hours postoperatively. Poor outcome infants had greater cumulative time with NIRS saturations less than 50% (60 vs 1.5 minutes; P = .02) in the first 24 hours. CONCLUSIONS: Within the first 24 hours after cardiopulmonary bypass, infants at increased risk for poor outcomes demonstrated elevated urinary NGAL, IL-18, and cystatin C and increased time with low NIRS saturations. These findings suggest that urinary biomarkers and renal NIRS may differentiate patients with good versus poor outcomes in the early postoperative period, which could assist clinicians when counseling families and inform the development of future clinical trials.
OBJECTIVE: To assess the ability of urinary acute kidney injury biomarkers and renal near-infrared spectroscopy (NIRS) to predict outcomes in infants after surgery for congenital heart disease. METHODS: Urinary levels of neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and cystatin C were measured preoperatively and postoperatively in 49 infants younger than 6 months of age. Renal NIRS was monitored for the first 24 hours after surgery. A composite poor outcome was defined as death, the need for renal replacement therapy, prolonged time to first extubation, or prolonged intensive care unit length of stay. RESULTS: Forty-two (86%) patients had acute kidney injury as indicated by at least Acute Kidney Injury Network/Kidney Disease: Improving Global Outcomes (AKIN/KDIGO) stage 1 criteria, and 17 (35%) patients had poor outcomes, including 3 deaths. With the exception of KIM-1, all biomarkers demonstrated significant increases within 24 hours postoperatively among patients with poor outcomes. Low levels of NGAL and IL-18 demonstrated high negative predictive values (91%) within 2 hours postoperatively. Poor outcome infants had greater cumulative time with NIRS saturations less than 50% (60 vs 1.5 minutes; P = .02) in the first 24 hours. CONCLUSIONS: Within the first 24 hours after cardiopulmonary bypass, infants at increased risk for poor outcomes demonstrated elevated urinary NGAL, IL-18, and cystatin C and increased time with low NIRS saturations. These findings suggest that urinary biomarkers and renal NIRS may differentiate patients with good versus poor outcomes in the early postoperative period, which could assist clinicians when counseling families and inform the development of future clinical trials.
Authors: Patrick S McQuillen; Michael S Nishimoto; Christine L Bottrell; Lori D Fineman; Shannon E Hamrick; David V Glidden; Anthony Azakie; Ian Adatia; Steven P Miller Journal: Pediatr Crit Care Med Date: 2007-03 Impact factor: 3.624
Authors: Catherine L Dent; James P Spaeth; Blaise V Jones; Steven M Schwartz; Tracy A Glauser; Barbara Hallinan; Jeffrey M Pearl; Philip R Khoury; C Dean Kurth Journal: J Thorac Cardiovasc Surg Date: 2005-12 Impact factor: 5.209
Authors: Kathy J Jenkins; Kimberlee Gauvreau; Jane W Newburger; Thomas L Spray; James H Moller; Lisa I Iezzoni Journal: J Thorac Cardiovasc Surg Date: 2002-01 Impact factor: 5.209
Authors: Joshua J Blinder; Stuart L Goldstein; Vei-Vei Lee; Alixandra Baycroft; Charles D Fraser; David Nelson; John L Jefferies Journal: J Thorac Cardiovasc Surg Date: 2011-07-27 Impact factor: 5.209
Authors: C R Parikh; J Mishra; H Thiessen-Philbrook; B Dursun; Q Ma; C Kelly; C Dent; P Devarajan; C L Edelstein Journal: Kidney Int Date: 2006-05-17 Impact factor: 10.612
Authors: A Akcan-Arikan; M Zappitelli; L L Loftis; K K Washburn; L S Jefferson; S L Goldstein Journal: Kidney Int Date: 2007-03-28 Impact factor: 10.612
Authors: Sharon H Wong; Kirsten Finucane; Alan R Kerr; Clare O'Donnell; Teena West; Thomas L Gentles Journal: Heart Lung Circ Date: 2007-07-31 Impact factor: 2.975
Authors: K R Pedersen; J V Povlsen; S Christensen; J Pedersen; K Hjortholm; S H Larsen; V E Hjortdal Journal: Acta Anaesthesiol Scand Date: 2007-11 Impact factor: 2.105
Authors: Phillip S Adams; Diana Vargas; Tracy Baust; Lucas Saenz; Wonshill Koh; Brian Blasiole; Patrick M Callahan; Aparna S Phadke; Khoa N Nguyen; Yuliya Domnina; Mahesh Sharma; John A Kellum; Joan Sanchez-de-Toledo Journal: Pediatr Crit Care Med Date: 2019-01 Impact factor: 3.624
Authors: Jef Van den Eynde; Art Schuermans; Jan Y Verbakel; Marc Gewillig; Shelby Kutty; Karel Allegaert; Djalila Mekahli Journal: Eur J Pediatr Date: 2022-01-17 Impact factor: 3.183
Authors: Matthew A Hazle; Robert J Gajarski; Sunkyung Yu; Janet Donohue; Neal B Blatt Journal: Pediatr Crit Care Med Date: 2013-01 Impact factor: 3.624
Authors: Sara L Van Driest; Edmund H Jooste; Yaping Shi; Leena Choi; Leon Darghosian; Kevin D Hill; Andrew H Smith; Prince J Kannankeril; Dan M Roden; Lorraine B Ware Journal: JAMA Pediatr Date: 2018-07-01 Impact factor: 16.193