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

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

LanguageEnglish
Pages1185-1191
Number of pages7
JournalPediatric Anesthesia
Volume21
Issue number12
DOIs
Publication statusPublished - 1 Dec 2011

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Cystatin C
Thoracic Surgery
Perfusion
Pediatrics
Kidney
Wounds and Injuries
Creatinine
Glomerular Filtration Rate
Cardiopulmonary Bypass
Troponin I
Oxygen
Pressure
Hematocrit
Acute Kidney Injury
Biomarkers

Keywords

  • biomarker
  • cardiopulmonary bypass
  • oxygen delivery
  • renal failure

Cite this

Vassalos, Antony ; Young, David ; MacArthur, Kenneth ; Pollock, James ; Lyall, Fiona ; Danton, Mark H.D. / Cystatin C : influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery. In: Pediatric Anesthesia. 2011 ; Vol. 21, No. 12. pp. 1185-1191.
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title = "Cystatin C: influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery",
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.",
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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 journalArticle

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

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U2 - 10.1111/j.1460-9592.2011.03654.x

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