Urinary Biomarkers may Complement the Cleveland Score for Prediction of Adverse Kidney Events After Cardiac Surgery: A Pilot Study
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Background: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. Methods: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. Results: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01–1.14]), Interleukin-6 (1.51 [1.01–2.26]), midkine (1.01 [1.00–1.02]), 1-hepcidin-25 (1.08 [1.00–1.17]), and NGAL/hepcidin-ratio (2.91 [1.30–6.49]) were independent predictors of MAKE and AKI (1.38 [1.03–1.85], 1.08 [1.01–1.15], 1.01 [1.00–1.02], 1.09 [1.01–1.18], and 3.45 [1.54–7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. Conclusions: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The com
Abstract
Background: The ability of urinary biomarkers to complement established clinical risk prediction models for postoperative adverse kidney events is unclear. We assessed the effect of urinary biomarkers linked to suspected pathogenesis of cardiac surgery-induced acute kidney injury (AKI) on the performance of the Cleveland Score, a risk assessment model for postoperative adverse kidney events. Methods: This pilot study included 100 patients who underwent open-heart surgery. We determined improvements to the Cleveland Score when adding urinary biomarkers measured using clinical laboratory platforms (neutrophil gelatinase-associated lipocalin [NGAL], interleukin-6) and those in the preclinical stage (hepcidin-25, midkine, alpha-1 microglobulin), all sampled immediately post-surgery. The primary endpoint was major adverse kidney events (MAKE), and the secondary endpoint was AKI. We performed ROC curve analysis, assessed baseline model performance (odds ratios [OR], 95% CI), and carried out statistical reclassification analyses to assess model improvement. Results: NGAL (OR [95% CI] per 20 concentration-units wherever applicable): (1.07 [1.01–1.14]), Interleukin-6 (1.51 [1.01–2.26]), midkine (1.01 [1.00–1.02]), 1-hepcidin-25 (1.08 [1.00–1.17]), and NGAL/hepcidin-ratio (2.91 [1.30–6.49]) were independent predictors of MAKE and AKI (1.38 [1.03–1.85], 1.08 [1.01–1.15], 1.01 [1.00–1.02], 1.09 [1.01–1.18], and 3.45 [1.54–7.72]). Category-free net reclassification improvement identified interleukin-6 as a model-improving biomarker for MAKE and NGAL for AKI. However, only NGAL/hepcidin-25 improved model performance for event- and event-free patients for MAKE and AKI. Conclusions: NGAL and interleukin-6 measured immediately post cardiac surgery may complement the Cleveland Score. The com
참고문헌 (38)
- Haase-Fielitz A, "Perioperative hemodynamic instability and fluid overload are associated with increasing acute kidney injury severity and worse outcome after cardiac surgery", Blood Purif, 43, pp.298~308 (2017)
- Kellum JA, "Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury", Kidney Int Suppl, 2, pp.1~138 (2012)
- Thakar CV, "A clinical score to predict acute renal failure after cardiac surgery", J Am Soc Nephrol, 16, pp.162~168 (2005)
- Vives M, "External validation and comparison of three scores to predict renal replacement therapy after cardiac surgery: a multicenter cohort", Int Artif Organs, 34, pp.329~338 (2011)
- McCullough PA, "Diagnosis of acute kidney injury using functional and injury biomarkers: workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference", Contrib Nephrol, 182, pp.13~29 (2013)
- Pencina MJ, "Evaluating the added predictive ability of a new marker : from area under the ROC curve to reclassification and beyond", Stat Med, 27, pp.157~172 (2008)
- Haase M, "Novel biomarkers, oxidative stress, and the role of labile iron toxicity in cardiopulmonary bypass-associated acute kidney injury", J Am Coll Cardiol, 55, pp.2024~2033 (2010)
- Renhua L, "The level of the biomarkers at the time of nephrology consultation might predict the prognosis of acute kidney injury in hospitalized patients", Blood Purif, 38, pp.89~95 (2014)
- Gueret G, "Acute renal dysfunction after cardiac surgery with cardiopulmonary bypass is associated with plasmatic IL6 increase", Cytokine, 45, pp.92~98 (2009)
- Haase M, "Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systemic review and meta-analysis", Am J Kidney Dis, 54, pp.1012~1024 (2009)
- Nemeth E, "The role of hepcidin in iron metabolism", Acta Haematol, 122, pp.78~86 (2009)
- Herget-Rosenthal S, "Prognostic value of tubular proteinuria and enzymuria in nonoliguric acute tubular necrosis", Clin Chem, 50, pp.552~558 (2004)
- Sato W, "Midkine is involved in neutrophil infiltration into the tubulointerstitium in ischemic renal injury", J Immunol, 167, pp.3463~3469 (2001)
- Hayashi H, "Efficacy of urinary midkine as a biomarker in patients with acute kidney injury", Clin Exp Nephrol, 21, pp.597~607 (2017)
- Ho J, "Urinary hepcidin-25 and risk of acute kidney injury following cardiopulmonary bypass", Clin J Am Soc Nephrol, 6, pp.2340~2346 (2011)
- Mårtensson J, "Urinary neutrophil gelatinase-associated lipocalin to hepcidin ratio as a biomarker of acute kidney injury in intensive care unit patients", Minerva Anestesiol, 81, pp.1192~1200 (2015)
- Haase M, "Prophylactic perioperative sodium bicarbonate to prevent acute kidney injury following open heart surgery: a multicenter double-blinded randomized controlled trial", PLoS Med, 10, pp.e1001426~ (2013)
- Bellomo R, "Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group", Crit Care, 8, pp.R204~R212 (2004)
- Englberger L, "Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery", Crit Care, 15, pp.R16~ (2011)
- Xiong J, "The RIFLE versus AKIN classification for incidence and mortality of acute kidney injury in critical ill patients : a meta-analysis", Sci Rep, 5, pp.1791717917~ (2015)
- Ganz T, "Immunoassay for human serum hepcidin", Blood, 112, pp.4292~4297 (2008)
- Pencina MJ, "Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers", Stat Med, 30, pp.11~21 (2011)
- Leening MJG, "Net reclassification improvement: computation, interpretation, and controversies: a literature review and clinician’s guide", Ann Intern Med, 160, pp.122~131 (2014)
- Albert C, "Urinary neutrophil gelatinase-associated lipocalin-guided risk assessment for major adverse kidney events after open-heart surgery", Biomark Med, 12, pp.975~985 (2018)
- 김소영, "Plasma Neutrophil Gelatinase-Associated Lipocalin as a Marker of Tubular Damage in Diabetic Nephropathy", Annals of Laboratory Medicine, 38(6), pp.524~529 (2018), 대한진단검사의학회
- Prowle JR, "Greater increase in urinary hepcidin predicts protection from acute kidney injury after cardiopulmonary bypass", Nephrol Dial Transplant, 27, pp.595~602 (2012)
- Mori K, "Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury", J Clin Invest, 115, pp.610~621 (2005)
- van Swelm RPL, "Renal handling of circulating and renal-synthesized hepcidin and its protective effects against hemoglobin-mediated kidney injury", J Am Soc Nephrol, 27, pp.2720~2732 (2016)
- Burne-Taney MJ, "Acute renal failure after whole body ischemia is characterized by inflammation and T cell-mediated injury", Am J Physiol Renal Physiol, 285, pp.F87~F94 (2003)
- Meersch M, "Prevention of cardiac surgery-associated AKI by implementing the KDIGO guidelines in high risk patients identified by biomarkers: the PrevAKI randomized controlled trial", Intensive Care Med, 43, pp.1551~1561 (2017)
- de Geus HR, "The cardiac surgery-associated neutrophil gelatinase-associated lipocalin (CSA-NGAL) score: a potential tool to monitor acute tubular damage", J Thorac Cardiovasc Surg, 151, pp.1476~1481 (2016)
- Haase M, "Electronic alerts for acute kidney injury", Dtsch Arztebl Int, 114, pp.1~8 (2017)
- Ho J, "Mass spectrometry-based proteomic analysis of urine in acute kidney injury following cardiopulmonary bypass : a nested case-control study", Am J Kidney Dis, 53, pp.584~595 (2009)
- Airola A, "An experimental comparison of cross-validation techniques for estimating the area under the ROC curve", Comput Stat Data Anal, 55, pp.1828~1844 (2011)
- Waikar SS, "Imperfect gold standards for kidney injury biomarker evaluation", J Am Soc Nephrol, 23, pp.13~21 (2012)
- 김한아, "Proenkephalin, Neutrophil Gelatinase-Associated Lipocalin, and Estimated Glomerular Filtration Rates in Patients With Sepsis", Annals of Laboratory Medicine, 37(5), pp.388~397 (2017), 대한진단검사의학회
- Haase M, "The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies", J Am Coll Cardiol, 57, pp.1752~1761 (2011)
- Albert C, "Urinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery", J Thorac Cardiovasc Surg, 155, pp.2441~2452.e13 (2018)