Abstract
Background: Cardiopulmonary bypass (CPB)-associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR). Aim: We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery. Methods: Twenty children, aged 4-58 months (AVSD, n = 7; VSD, n = 9; and ASD, n = 4), were prospectively studied. Glomerular filtration rate was quantified postoperatively by creatinine clearance (first and second 12-h periods; CrCl 0-12 and CrCl 12-24). Serum cystatin C and Cr were measured preoperatively and on days 0-3. Recorded CPB parameters included bypass duration (BP), perfusion pressure (PP), lowest pump flow (Q min), lowest hematocrit, and corresponding lowest oxygen delivery (DO 2 min). Myocardial injury was determined by troponin-I. Results: Postoperatively, GFR remained unchanged (CrCl 0-12 63.6 ± 37.0 vs CrCl 12-24 65.1 ± 27.5; P = 0.51) and only correlated with cystatin C (CrCl 0-12 vs cystatin C Day0 [r = 0.58, P = 0.018] and Cr Day0 [r = 0.09, P = 0.735]). Cr and cystatin C increased postoperatively to peak on days 2 and 3, respectively (Cr PreOp 31 ± 6.9 vs Cr Day2 36.9 ± 12.2, P = 0.03; cystatin C Day0 0.83 ± 0.27 vs cystatin C Day3 1.45 ± 0.53, P = 0.02). Increased cystatin C was significantly associated with BP (P = 0.001), mean PP (P = 0.029), Q min (P = 0.005), troponin-I (P < 0.001), and DO 2min <300 ml·min -1·m -2 (P = 0.007). Receiver-operator cutoff >1.044 mg·l -1 for cystatin C exhibited 100% sensitivity and 67% specificity for detecting renal dysfunction, defined as GFR <55 ml·min -1·1.73 m -2. Conclusions: Cystatin C is a sensitive marker of early renal dysfunction following pediatric heart surgery. Variations in bypass parameters, myocardial injury, and ultimately critical oxygen delivery are significantly associated with the degree of renal impairment.
| Language | English |
|---|---|
| Pages | 1185-1191 |
| Number of pages | 7 |
| Journal | Pediatric Anesthesia |
| Volume | 21 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 1 Dec 2011 |
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Keywords
- biomarker
- cardiopulmonary bypass
- oxygen delivery
- renal failure
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Cystatin C : influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery. / Vassalos, Antony; Young, David; MacArthur, Kenneth; Pollock, James; Lyall, Fiona; Danton, Mark H.D.
In: Pediatric Anesthesia, Vol. 21, No. 12, 01.12.2011, p. 1185-1191.Research output: Contribution to journal › Article
TY - JOUR
T1 - Cystatin C
T2 - Pediatric Anesthesia
AU - Vassalos, Antony
AU - Young, David
AU - MacArthur, Kenneth
AU - Pollock, James
AU - Lyall, Fiona
AU - Danton, Mark H.D.
PY - 2011/12/1
Y1 - 2011/12/1
N2 - Background: Cardiopulmonary bypass (CPB)-associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR). Aim: We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery. Methods: Twenty children, aged 4-58 months (AVSD, n = 7; VSD, n = 9; and ASD, n = 4), were prospectively studied. Glomerular filtration rate was quantified postoperatively by creatinine clearance (first and second 12-h periods; CrCl 0-12 and CrCl 12-24). Serum cystatin C and Cr were measured preoperatively and on days 0-3. Recorded CPB parameters included bypass duration (BP), perfusion pressure (PP), lowest pump flow (Q min), lowest hematocrit, and corresponding lowest oxygen delivery (DO 2 min). Myocardial injury was determined by troponin-I. Results: Postoperatively, GFR remained unchanged (CrCl 0-12 63.6 ± 37.0 vs CrCl 12-24 65.1 ± 27.5; P = 0.51) and only correlated with cystatin C (CrCl 0-12 vs cystatin C Day0 [r = 0.58, P = 0.018] and Cr Day0 [r = 0.09, P = 0.735]). Cr and cystatin C increased postoperatively to peak on days 2 and 3, respectively (Cr PreOp 31 ± 6.9 vs Cr Day2 36.9 ± 12.2, P = 0.03; cystatin C Day0 0.83 ± 0.27 vs cystatin C Day3 1.45 ± 0.53, P = 0.02). Increased cystatin C was significantly associated with BP (P = 0.001), mean PP (P = 0.029), Q min (P = 0.005), troponin-I (P < 0.001), and DO 2min <300 ml·min -1·m -2 (P = 0.007). Receiver-operator cutoff >1.044 mg·l -1 for cystatin C exhibited 100% sensitivity and 67% specificity for detecting renal dysfunction, defined as GFR <55 ml·min -1·1.73 m -2. Conclusions: Cystatin C is a sensitive marker of early renal dysfunction following pediatric heart surgery. Variations in bypass parameters, myocardial injury, and ultimately critical oxygen delivery are significantly associated with the degree of renal impairment.
AB - Background: Cardiopulmonary bypass (CPB)-associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR). Aim: We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery. Methods: Twenty children, aged 4-58 months (AVSD, n = 7; VSD, n = 9; and ASD, n = 4), were prospectively studied. Glomerular filtration rate was quantified postoperatively by creatinine clearance (first and second 12-h periods; CrCl 0-12 and CrCl 12-24). Serum cystatin C and Cr were measured preoperatively and on days 0-3. Recorded CPB parameters included bypass duration (BP), perfusion pressure (PP), lowest pump flow (Q min), lowest hematocrit, and corresponding lowest oxygen delivery (DO 2 min). Myocardial injury was determined by troponin-I. Results: Postoperatively, GFR remained unchanged (CrCl 0-12 63.6 ± 37.0 vs CrCl 12-24 65.1 ± 27.5; P = 0.51) and only correlated with cystatin C (CrCl 0-12 vs cystatin C Day0 [r = 0.58, P = 0.018] and Cr Day0 [r = 0.09, P = 0.735]). Cr and cystatin C increased postoperatively to peak on days 2 and 3, respectively (Cr PreOp 31 ± 6.9 vs Cr Day2 36.9 ± 12.2, P = 0.03; cystatin C Day0 0.83 ± 0.27 vs cystatin C Day3 1.45 ± 0.53, P = 0.02). Increased cystatin C was significantly associated with BP (P = 0.001), mean PP (P = 0.029), Q min (P = 0.005), troponin-I (P < 0.001), and DO 2min <300 ml·min -1·m -2 (P = 0.007). Receiver-operator cutoff >1.044 mg·l -1 for cystatin C exhibited 100% sensitivity and 67% specificity for detecting renal dysfunction, defined as GFR <55 ml·min -1·1.73 m -2. Conclusions: Cystatin C is a sensitive marker of early renal dysfunction following pediatric heart surgery. Variations in bypass parameters, myocardial injury, and ultimately critical oxygen delivery are significantly associated with the degree of renal impairment.
KW - biomarker
KW - cardiopulmonary bypass
KW - oxygen delivery
KW - renal failure
UR - http://www.scopus.com/inward/record.url?scp=80055012165&partnerID=8YFLogxK
UR - http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2011.03654.x/abstract
U2 - 10.1111/j.1460-9592.2011.03654.x
DO - 10.1111/j.1460-9592.2011.03654.x
M3 - Article
VL - 21
SP - 1185
EP - 1191
JO - Pediatric Anesthesia
JF - Pediatric Anesthesia
SN - 1155-5645
IS - 12
ER -