医学
急性肾损伤
泌尿系统
生物标志物
肌酐
透析
辛迪康1
前瞻性队列研究
泌尿科
四分位数
内科学
外科
置信区间
生物化学
化学
遗传学
生物
细胞
作者
Natalia Monte Benevides Ferrer,Candice Torres de Melo Bezerra Cavalcante,Klébia Magalhães Castelo Branco,Valdester Cavalcante Pinto Júnior,Gdayllon Cavalcante Meneses,Fernanda Macedo de Oliveira Neves,Nayana Maria Gomes de Souza,Kiarelle LourençoPenaforte,Alice Maria Costa Martins,Alexandre Braga Libório
标识
DOI:10.1016/j.cca.2018.06.033
摘要
Acute kidney injury (AKI) is a common occurrence after pediatric cardiac surgery. Plasma syndecan-1 is a biomarker of endothelial glycocalyx damage and it is associated with AKI. Syndecan-1 is also expressed in renal tubular cells but there is no study evaluating urinary syndecan-1 in predicting AKI.Prospective cohort study with 86 patients ≤18 years submitted to cardiac surgery at one reference institution. Postoperative urinary syndecan-1 was collected within the first 2 h after cardiac surgery. Severe AKI - defined according to KDIGO as stage 2 or 3 - doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization was the main outcome. Analyses were adjusted for clinical cofounders.Postoperative urinary syndecan-1 levels were higher in patients with severe AKI and even after adjustment for several clinical variables; the fourth quartile was significantly associated with severe AKI. The AUC-ROC for postoperative urinary syndecan-1 showed good discriminatory capacity (AUC-ROC = 0.793). The addition of urinary syndecan-1 improved the discrimination capacity of a clinical model (0.78 to 0.84). It also improved risk prediction, as measured by net reclassification improvement (NRI).Urinary syndecan-1 predicts severe AKI after pediatric cardiac surgery. Moreover, it appears to add capacity to predict severe AKI into a clinical model.
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