Original InvestigationPathogenesis and Treatment of Kidney DiseasePresurgical Serum Cystatin C and Risk of Acute Kidney Injury After Cardiac Surgery
Section snippets
Design and Setting
The TRIBE-AKI (Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury) Study is an investigator-initiated study that was funded by the National Heart, Lung, and Blood Institute. The primary objective of this study is to investigate novel biomarkers for the early detection of AKI. A second aim of the study is to identify novel presurgical biomarkers for AKI, with cystatin C having been proposed as the leading candidate. We conducted a prospective cohort study of adults
Baseline Characteristics
Of 1,220 adults enrolled in this study, 73 did not have serum cystatin C results, leaving 1,147 with all 3 measurements of kidney function. Mean age was 71 ± 10 (standard deviation) years; 68% (n = 780) were men, and 93% (n = 1,072) were white. Of the surgical procedures, 48% (n = 551) were bypass only, 29% (n = 332) were valve only, and 30% (n = 263) were both; 80% of surgeries were elective and 13% were repeated operations. Presurgical kidney function levels were as follows: cystatin C, 0.93
Discussion
AKI is among the most morbid complications of cardiac surgery. Not only does AKI lead to higher in-hospital mortality risk, but it also predisposes to long-term mortality risk, even in persons who appear to recover from the AKI episode.18, 19 In this large multicenter prospective study, we compared the ability of presurgical measurement of serum cystatin C, an alternative marker of kidney filtration, with the clinical standard of serum creatinine to risk-stratify for postsurgical AKI. Although
Acknowledgements
Members of the TRIBE-AKI Consortium are Charles L. Edelstein, Michael Zappitelli, Catherine D. Krawczeski, Madhav Swaminathan, Cary S. Passik, Simon Li, and Michael Bennett.
Support: The research reported in this article was supported by the American Heart Association Clinical Development award and grant RO1HL-085757 from the National Heart, Lung, and Blood Institute. The study was also supported by Clinical Translational Science Award grant number UL1 RR024139 from the National Center for
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2017, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :The additive role of each biomarker confirmed the authors’ hypothesis regarding the importance of including biomarkers from different pathophysiologic pathways. Previous studies on preoperative biomarkers of AKI have considered only high-risk patients.7,8 Shlipak et al 8 investigated the in which of preoperative cystatin C on AKI risk prediction, in which addition of cystatin C to a baseline clinical model increased AUC from 0.70 to 0.72 (p<0.01) and led to an NRI of 21%.
Predictive value of cystatin C for the identification of illness severity in adult patients in a mixed intensive care unit
2016, Clinical BiochemistryCitation Excerpt :Specifically, an increase in the serum CysC levels may detect initial abnormalities that are undetectable by conventional renal biomarkers. Therefore, CysC can be considered a sensitive prognostic indicator for clinical evaluation and, in particular, one that may be associated with unfavorable outcomes or death [16,26]. Recent findings have indicated that several variables, such as tissue adipose mass, gender or inflammatory status, may interfere with CysC levels and other traditional renal biomarkers [12,27,28].
Originally published online May 23, 2011.
Because the Editor-in-Chief recused himself from consideration of this manuscript, the Deputy Editor (Daniel E. Weiner, MD, MS) served as Acting Editor-in-Chief. Details of the journal's procedures for potential editor conflicts are given in the Editorial Policies section of the AJKD website.
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A list of the members of the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury) Consortium is provided in the Acknowledgments.