Predictive Value of Serum Soluble ST2 in Adult Patients Undergoing Cardiac Surgery for Acute Kidney Injury.

Cardiac surgery is related to an increased risk of postoperative acute kidney injury (AKI). Serum soluble ST2 (sST2) is highly predictive of several cardiovascular diseases and may also be involved in renal injury. This study explored the relationship between serum sST2 levels measured at intensive care unit (ICU) admission and the development of AKI after cardiac surgery. We prospectively conducted an investigation on consecutive patients who underwent cardiac surgery. sST2 was immediately measured at ICU admission. The relationship between the levels of sST2 and the development of AKI was explored using stepwise logistic regression. Among the 500 patients enrolled, AKI was observed in 207 (41%) patients. Serum sST2 levels in AKI patients were higher than those without AKI (61.46 ng/mL [46.52, 116.25] vs. 38.91 ng/mL [28.74, 50.93], p < 0.001). Additionally, multivariable logistic regression analysis showed that as progressively higher tertiles of serum sST2, the odds ratios (ORs) of AKI gradually increased (adjusted ORs of 1.97 [95% CI, 1.13-3.45], and 4.27 [95% CI, 2.36-7.71] for tertiles 2 and 3, respectively, relative to tertile 1, p < 0.05). The addition of sST2 further improved reclassification (p < 0.001) and discrimination (p < 0.001) over the basic model, which included established risk factors. Serum sST2 levels at ICU admission were associated with the development of postoperative AKI and improved the identification of AKI after cardiac surgery.

Chen Z ，Li J ，Liu X ，Liu X ，Zhu J ，Tang X ，Deng Y ，Chen C ... -  《-》

Preoperative serum ST2 level predicts acute kidney injury after adult cardiac surgery.

The purpose of this study was to evaluate the relationship between preoperative levels of serum soluble ST2 (ST2) and acute kidney injury (AKI) after cardiac surgery. Previous research has shown that biomarkers facilitate the prediction of AKI and other complications after cardiac surgery. Preoperative ST2 proteins were measured in 1498 patients undergoing isolated coronary artery bypass graft surgery at 8 hospitals participating in the Northern New England Biomarker Study from 2004 to 2007. AKI severity was defined using the Acute Kidney Injury Network (AKIN) definition. Preoperative ST2 levels were measured using multiplex assays. Ordered logistic regression was used to examine the relationship between ST2 levels and levels of AKI severity. Participants in this study showed a significant association between elevated preoperative ST2 levels and acute kidney risk. Before adjustment, the odds of patients developing AKIN stage 2 or 3, compared with AKIN stage 1, are 2.43 times higher (95% confidence interval, 1.86-3.16; P < .001) for patients in the highest tercile of preoperative ST2. After adjustment, patients in the highest tercile of preoperative ST2 had significantly greater odds of developing AKIN stage 2 or 3 AKI (odds ratio, 1.99; 95% confidence interval, 1.50-2.65; P < .001) compared with patients with AKIN stage 1. Preoperative ST2 levels are associated with postoperative AKI risk and can be used to identify patients at higher risk of developing AKI after cardiac surgery.

Lobdell KW ，Parker DM ，Likosky DS ，Rezaee M ，Wyler von Ballmoos M ，Alam SS ，Owens S ，Thiessen-Philbrook H ，MacKenzie T ，Brown JR ... -  《-》

Association of plasma-soluble ST2 and galectin-3 with cardiovascular events and mortality following cardiac surgery.

Cardiac surgery induces hemodynamic stress on the myocardium, and this process can be associated with significant post-operative morbidity and mortality. Soluble suppression of tumorigenicity 2 (sST2) and galectin-3 (gal-3) are biomarkers of myocardial remodeling and fibrosis; however, their potential association with post-operative changes is unknown. We measured peri-operative plasma sST2 and gal-3 levels in two prospective cohorts (TRIBE-AKI and NNE) of over 1800 patients who underwent cardiac surgery. sST2 and gal-3 levels were evaluated for association with a composite primary outcome of cardiovascular event or mortality over median follow-up periods of 3.4 and 6.0 years, respectively, for the two cohorts. Meta-analysis of hazard ratio estimates from the cohorts was performed using random effects models. Cohorts demonstrated event rates of 70.2 and 66.8 per 1000 person-years for the primary composite outcome. After adjustment for clinical covariates, higher post-operative sST2 and gal-3 levels were significantly associated with cardiovascular event or mortality [pooled estimate HRs: sST2 1.29 (95% CI 1.16, 1.44); gal-3 1.26 (95% CI 1.09, 1.46)]. These associations were not significantly modified by pre-operative congestive heart failure or AKI. Higher post-operative sST2 and gal-3 values were associated with increased incidence of cardiovascular event or mortality. These two biomarkers should be further studied for potential clinical utility for patients undergoing cardiac surgery.

Patel DM ，Thiessen-Philbrook H ，Brown JR ，McArthur E ，Moledina DG ，Mansour SG ，Shlipak MG ，Koyner JL ，Kavsak P ，Whitlock RP ，Everett AD ，Malenka DJ ，Garg AX ，Coca SG ，Parikh CR ... -  《-》

Early serum cystatin C-enhanced risk prediction for acute kidney injury post cardiac surgery: a prospective, observational, cohort study.

Wang X ，Lin X ，Xie B ，Huang R ，Yan Y ，Liu S ，Zhu M ，Lu R ，Qian J ，Ni Z ，Xue S ，Che M ... -  《-》

Predictive value of perioperative NT-proBNP levels for acute kidney injury in patients with compromised renal function undergoing cardiac surgery: a case control study.

Acute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and dysfunction, conditions often exacerbated during cardiac surgery and prevalent in chronic kidney disease (CKD) patients. Elevated NT-proBNP levels can indicate underlying cardiac strain, hemodynamic instability and volume overload. This study evaluated the association between perioperative changes in NT-proBNP levels and the incidence of AKI in this particular patient group. This retrospective study involved patients with impaired renal function (eGFR 15-60 ml/min/1.73 m²) who underwent cardiac surgery from July to December 2022. It analyzed the association between the ratio of preoperative and ICU admittance post-surgery NT-proBNP levels and the development of AKI and AKI stage 2-3, based on KDIGO criteria, using multivariate logistic regression models. Restricted cubic spline analysis assessed non-linear associations between NT-proBNP and endpoints. Subgroup analysis was performed to assess the heterogeneity of the association between NT-proBNP and endpoints in subgroups. Among the 199 participants, 116 developed postoperative AKI and 16 required renal replacement therapy. Patients with AKI showed significantly higher postoperative NT-proBNP levels compared to those without AKI. Decreased baseline eGFR and increased post/preoperative NT-proBNP ratios were associated with higher AKI risk. Specifically, the highest quantile post/preoperative NT-proBNP ratio indicated an approximately seven-fold increase in AKI risk and a ninefold increase in AKI stage 2-3 risk compared to the lowest quantile. The area under the receiver operating characteristic curve for predicting AKI and AKI stage 2-3 using NT-proBNP were 0.63 and 0.71, respectively, demonstrating moderate accuracy. Subgroup analysis demonstrated that the positive association between endpoints and logarithmic transformed post/preoperative NT-proBNP levels was consistently robust in subgroup analyses stratified by age, sex, surgery, CPB application, hypertension, diabetes status and fluid balance. Perioperative NT-proBNP level changes are predictive of postoperative AKI in patients with pre-existing renal deficiencies undergoing cardiac surgery, aiding in risk assessment and patient management.

Ma Y ，Zheng J ，Zhou W ，Luo Z ，Jiang W ... -  《BMC Anesthesiology》