New and available biomarker to predict acute kidney injury after pediatric cardiac surgery

Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Children with Congenital Heart Diseases in Southwest Nigeria

METHOD

This was a prospective, longitudinal study, of 40 children who had open heart surgery, on account of congenital heart diseases, at our study center, between April 2020 and June 2022. Plasma samples were assayed for cystatin-C using the enzyme-linked immunosorbent assay method, while quantification of creatinine was done using a Roche automated analyzer (Cobas C311).

RESULT

Mean plasma concentrations of cystatin-C at 0, 4, 8, 12, 24 and 48 hours were 0.49±0.11 ng/dL, 0.75 ± 0.19 ng/dL, 0.96 ± 0.23 ng/dL, 0.79 ± 0.20 ng/dL, 0.66 ± 0.15 ng/dL, and 0.60 ± 0.14 ng/dL, respectively, versus 48.98 ± 11.6 μmol/L, 59.65 ± 13.06 μmol/L, 63.00 ± 16.53 μmol/L, 64.90 ± 17.65 μmol/L, 68.50 ± 19.99 μmol/L, and 70.78 ± 21.86 μmol/L, respectively, of creatinine. Plasma cystatin-C peaked earlier at 8 hours compared to creatinine, which peaked at 48 hours. The ROC curve showed that cystatin-C had an AUC of 0.983.

CONCLUSION

This study showed that cystatin-C has a better sensitivity and specificity than creatinine in predicting CSA-AKI in children who had open heart surgery for congenital heart diseases.

Development and Validation of a Nomogram for Predicting Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery

Acute kidney injury (AKI) is a common complication after cardiac surgery and associated with adverse outcomes. The purpose of this study is to construct a nomogram to predict the probability of postoperative AKI in pediatric patients undergoing cardiac surgery. We conducted a single-center retrospective cohort study of 1137 children having cardiac surgery under cardiopulmonary bypass. We randomly divided the included patients into development and validation cohorts at a ratio of 7:3. The least absolute shrinkage and selection operator regression model was used for feature selection. We constructed a multivariable logistic regression model to select predictors and develop a nomogram to predict AKI risk. Discrimination, calibration and clinical benefit of the final prediction model were evaluated in the development and validation cohorts. A simple nomogram was developed to predict risk of postoperative AKI using six predictors including age at operation, cyanosis, CPB duration longer than 120 min, cross-clamp time, baseline albumin and baseline creatinine levels. The area under the receiver operator characteristic curve of the nomogram was 0.739 (95% CI 0.693-0.786) and 0.755 (95% CI 0.694-0.816) for the development and validation cohort, respectively. The calibration curve showed a good correlation between predicted and observed risk of postoperative AKI. Decision curve analysis presented great clinical benefit of the nomogram. This novel nomogram for predicting AKI after pediatric cardiac surgery showed good discrimination, calibration and clinical practicability.

Motor Vehicle Collision and Acute Kidney Injury in Children

OBJECTIVE

Our study aimed to determine the prevalence of acute kidney injury (AKI) in pediatric patients who sustained trauma due to motor vehicle collision (MVC) and identify factors associated with its development.

METHODS

We retrospectively reviewed the clinical information and laboratory tests of pediatric patients who were admitted because of MVC from January 2014 to April 2021. The occurrence of AKI was our primary outcome, which was defined by the Kidney Disease Improving Global Outcomes criteria. A serum creatine kinase (CK) level of 1000 IU/L or greater was defined as rhabdomyolysis.

RESULTS

Sixty-four patients (median age, 9.6 years) were included in the study. Twenty three of the patients (35.9%) developed AKI: stage 1 AKI in 18 (78.3%) and stage 2 AKI in 5 (21.7%) patients. Acute kidney injury patients had higher injury severity scores (no AKI: 5.0; stage 1 AKI: 10.5; stage 2 AKI: 26.0). Rhabdomyolysis was present in 21.1% of the patients and was associated with the overall AKI risk (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.6-32.6) and stage 2 AKI (OR, 15.0; 95% CI, 1.4-163.2). Blood tests from AKI patients showed lower serum bicarbonate and base excess, higher leukocyte and CK levels on admission, and a higher peak CK in the first 72 hours of admission. Intubation in emergency department (OR, 11.1; 95% CI, 1.2-102.1) and surgical interventions (OR, 3.2; 95% CI, 1.0-9.8) were associated with AKI. Acute kidney injury patients required longer stay in pediatric intensive care unit (median 1.0 vs 2.3 days, P < 0.001) and hospital (median 4.1 vs 7.0 days, P = 0.010).

CONCLUSIONS

Approximately one third of pediatric patients who sustained trauma from MVC developed AKI. Initial blood results, including higher CK and leukocyte count, and lower bicarbonate and base excess, were associated with the development of AKI. Rhabdomyolysis occurred in approximately one fifth of the patients and was significantly associated with AKI.