Cystatin C: influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery

Antony Vassalos, David Young, Kenneth MacArthur, James Pollock, Fiona Lyall, Mark H.D. Danton

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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.

Original languageEnglish
Pages (from-to)1185-1191
Number of pages7
JournalPediatric Anesthesia
Volume21
Issue number12
DOIs
Publication statusPublished - 1 Dec 2011

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Keywords

  • biomarker
  • cardiopulmonary bypass
  • oxygen delivery
  • renal failure

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