Interleukin-8 and Tumor Necrosis Factor Predict Acute Kidney Injury After Pediatric Cardiac Surgery.

Inflammation is a key component of both acute kidney injury (AKI) and response to cardiopulmonary bypass. Because AKI poses risks to children after cardiac surgery, we investigated the value of inflammatory biomarkers interleukin-8 (IL-8) and tumor necrosis factor alpha (TNFα) for predicting AKI and other complications. We enrolled 412 children between the ages of 1 month and 18 years undergoing cardiopulmonary bypass for cardiac surgery. We collected blood both preoperatively and postoperatively (within 6 hours post-surgery) and measured plasma IL-8 and TNFα. IL-8 and TNFα did not predict AKI in children <2 years, but were strongly associated with AKI in children ≥2 years. There were significant associations between biomarker levels and age (<2 or ≥2 years). In children ≥2 years, patients in the highest tertile of preoperative IL-8 and postoperative TNFα had 4.9-fold (95% CI: 1.8-13.2) and 3.3-fold (95% CI: 1.2-9.0) higher odds of AKI compared with those in the lowest tertile. Children <2 years with higher biomarker levels also had higher odds of AKI, but the difference was not significant. We also found that postoperative TNFα levels were significantly higher in patients with longer hospital stays, and that both postoperative IL-8 and TNFα levels were significantly higher in patients with longer ventilation lengths. There was no evidence that biomarker levels mediated the association between AKI and length of ventilation; they appear to be independent predictors. Preoperative IL-8 and postoperative TNFα are significantly associated with higher odds of AKI and greater lengths of hospital stays and ventilator use in children 2 years and older.

de Fontnouvelle CA ，Greenberg JH ，Thiessen-Philbrook HR ，Zappitelli M ，Roth J ，Kerr KF ，Devarajan P ，Shlipak M ，Coca S ，Parikh CR ，TRIBE-AKI Consortium ... -  《-》

Interleukin-6 and interleukin-10 as acute kidney injury biomarkers in pediatric cardiac surgery.

Greenberg JH ，Whitlock R ，Zhang WR ，Thiessen-Philbrook HR ，Zappitelli M ，Devarajan P ，Eikelboom J ，Kavsak PA ，Devereaux PJ ，Shortt C ，Garg AX ，Parikh CR ，TRIBE-AKI Consortium ... -  《-》

Pre-operative level of FGF23 predicts severe acute kidney injury after heart surgery in children.

Volovelsky O ，Terrell TC ，Swain H ，Bennett MR ，Cooper DS ，Goldstein SL ... -  《-》

Association of definition of acute kidney injury by cystatin C rise with biomarkers and clinical outcomes in children undergoing cardiac surgery.

Zappitelli M ，Greenberg JH ，Coca SG ，Krawczeski CD ，Li S ，Thiessen-Philbrook HR ，Bennett MR ，Devarajan P ，Parikh CR ，Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) Consortium ... -  《-》

Cardiac biomarkers and acute kidney injury after cardiac surgery.

To examine the relationship of cardiac biomarkers with postoperative acute kidney injury (AKI) among pediatric patients undergoing cardiac surgery. Data from TRIBE-AKI, a prospective study of children undergoing cardiac surgery, were used to examine the association of cardiac biomarkers (N-type pro-B-type natriuretic peptide, creatine kinase-MB [CK-MB], heart-type fatty acid binding protein [h-FABP], and troponins I and T) with the development of postoperative AKI. Cardiac biomarkers were collected before and 0 to 6 hours after surgery. AKI was defined as a ≥ 50% or 0.3 mg/dL increase in serum creatinine, within 7 days of surgery. Of the 106 patients included in this study, 55 (52%) developed AKI after cardiac surgery. Patients who developed AKI had higher median levels of pre- and postoperative cardiac biomarkers compared with patients without AKI (all P < .01). Preoperatively, higher levels of CK-MB and h-FABP were associated with increased odds of developing AKI (CK-MB: adjusted odds ratio 4.58, 95% confidence interval [CI] 1.56-13.41; h-FABP: adjusted odds ratio 2.76, 95% CI 1.27-6.03). When combined with clinical models, both preoperative CK-MB and h-FABP provided good discrimination (area under the curve 0.77, 95% CI 0.68-0.87, and 0.78, 95% CI 0.68-0.87, respectively) and improved reclassification indices. Cardiac biomarkers collected postoperatively did not significantly improve the prediction of AKI beyond clinical models. Preoperative CK-MB and h-FABP are associated with increased risk of postoperative AKI and provide good discrimination of patients who develop AKI. These biomarkers may be useful for risk stratifying patients undergoing cardiac surgery.

Bucholz EM ，Whitlock RP ，Zappitelli M ，Devarajan P ，Eikelboom J ，Garg AX ，Philbrook HT ，Devereaux PJ ，Krawczeski CD ，Kavsak P ，Shortt C ，Parikh CR ，TRIBE-AKI Consortium ... -  《-》