Yosuke Mori1, Nobukazu Sato2, Yoshiro Kobayashi3, Ryoichi Ochiai2. 1. Department of Anesthesia, Kawasaki Saiwai Hospital, 31-27 Omiya Saiwai Kawasaki, Kanagawa 212-0014, Japan. Electronic address: yosuke@mori.name. 2. Department of Anesthesiology, Toho University, School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo143-8540, Japan. 3. Department of Anesthesia, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902 Japan.
Abstract
STUDY OBJECTIVE: To examine the change in liver-type fatty acid-binding protein (L-FABP) levels in patients undergoing aortic arch surgery and the correlation between L-FABP and postoperative acute kidney injury. DESIGN: Prospective observational study. SETTING: Operating room of a general hospital. PATIENTS: 36 adult patients. INTERVENTIONS AND MEASUREMENTS: Urine samples were obtained to measure urinary L-FABP at initiation of cardiopulmonary bypass (CPB) and 5 minutes after termination of hypothermic circulatory arrest. MAIN RESULTS: 22 (61.1%) patients developed acute kidney injury within a 48-hour period. L-FABP increases more than a thousand-fold were found. In patients who subsequently developed acute kidney injury, significant increases in L-FABP were noted from 2.9 (3.6) ng/mg of creatinine before CPB to 62.1 (995.6) ng/mg of creatinine 5 minutes after termination of circulatory arrest. Values in patients who did not develop acute kidney injury increased from 1.1 (5.7) ng/mg before CPB to 1133.0 (6358.8) ng/mg of creatinine showing a significant mean difference (P = 0.011). The area under the L-FABP receiver operating characteristic curve at 5 minutes after termination of circulatory arrest was 0.758. A cutoff value of 75.13 ng/mg of creatinine yielded both good sensitivity (1.000) and specificity (0.546) for detecting non-acute kidney injury. Patients who developed acute kidney injury after aortic arch surgery demonstrated lower levels of urinary L-FABP. CONCLUSIONS: Low levels of urinary L-FABP may indicate kidney injury and lack of renal protection.
STUDY OBJECTIVE: To examine the change in liver-type fatty acid-binding protein (L-FABP) levels in patients undergoing aortic arch surgery and the correlation between L-FABP and postoperative acute kidney injury. DESIGN: Prospective observational study. SETTING: Operating room of a general hospital. PATIENTS: 36 adult patients. INTERVENTIONS AND MEASUREMENTS: Urine samples were obtained to measure urinary L-FABP at initiation of cardiopulmonary bypass (CPB) and 5 minutes after termination of hypothermic circulatory arrest. MAIN RESULTS: 22 (61.1%) patients developed acute kidney injury within a 48-hour period. L-FABP increases more than a thousand-fold were found. In patients who subsequently developed acute kidney injury, significant increases in L-FABP were noted from 2.9 (3.6) ng/mg of creatinine before CPB to 62.1 (995.6) ng/mg of creatinine 5 minutes after termination of circulatory arrest. Values in patients who did not develop acute kidney injury increased from 1.1 (5.7) ng/mg before CPB to 1133.0 (6358.8) ng/mg of creatinine showing a significant mean difference (P = 0.011). The area under the L-FABP receiver operating characteristic curve at 5 minutes after termination of circulatory arrest was 0.758. A cutoff value of 75.13 ng/mg of creatinine yielded both good sensitivity (1.000) and specificity (0.546) for detecting non-acute kidney injury. Patients who developed acute kidney injury after aortic arch surgery demonstrated lower levels of urinary L-FABP. CONCLUSIONS: Low levels of urinary L-FABP may indicate kidney injury and lack of renal protection.