KARDİYAK CERRAHİ GEÇİREN ERİŞKİN HASTALARDA POSTOPERATİF SİSTATİN-C DÜZEYİNİN ERKEN DÖNEMDE AKUT BÖBREK YETMEZLİĞİ İLE İLİŞKİSİ

Year 2023, Volume: 4 Issue: Ek Sayı, 220 - 226, 16.10.2023

Evren Tecer , Sümeyra Alan Yalım , Mustafa Aldemir

Abstract

Giriş: Kardiyovasküler hastalıklar halen dünyada mortalite ve morbiditenin en önemli nedenidir. Kalp cerrahisi hastanelerde en sık uygulanan büyük cerrahi girişimler olup, cerrahi sonrası gelişen akut böbrek hasarı (ABH) sıklıkla karşılaşılan ve mortaliteyi arttıran önemli bir durumdur. Operasyon sonrası gelişebilecek ABH erken tanısının belirlenmesi tedavi başarısını yükseltebilir. Biz de bu çalışmada kardiyak cerrahi geçiren hastalarda postoperative Cystatin C düzeyinin erken dönem akut böbrek yetmezliği ile ilişkisini değerlendirmeyi amaçladık.
Yöntemler: Çalışmamız 2016 - 2017 yılları arasında kardiyak operasyon geçiren, 18 yaşından büyük, başlangıç böbrek fonksiyonu normal (kreatinin <1,2 mg/dL) 40 erişkin hasta ile yapıldı. Hastaların bazal demografik özellikleri, biyokimya parametreleri kayıt edildi. Plazma Cystatin C seviyesi postop 6. saat ve 24. saat örnekleri alınarak postop ABH arasındaki ilişkisi araştırıldı.
Bulgular: Çalışmamızda 40 hastadan 12’sine Akut Kidney Injury Network (AKIN) ve 14’üne Risk-Injury-Failure-Loss-End stage (RIFLE) sınıflamasına göre ABH tanısı konuldu. ABH gelişmesi ile hastanede kalış süresinin anlamlı olarak arttığı, 24. saat Cystatin C seviyesinin ABH gelişmesi ile korele olduğu (p=0.048) ve ABH gelişen grupta anlamlı olarak yüksek olduğu belirlendi. Başlangıç diyabet varlığı ABH gelişen hastalarda anlamlı olarak yüksekti (p=0.045). Plazma Cystatin C 24. saat AUCROC değeri 0,78 (0,75-0,90 Güven aralığı, p:0.002) olarak hesaplandı. 6.saatte bakılan Cystatin C seviyesi ile ABH arasında korelasyon yoktu (p=0.358).
Sonuç: Kardiyak cerrahi sonrası ABH gelişmesi olumsuz klinik olay sıklığı ile ilişkilidir. 6.saat bakılan Cystatin C erken tanıda duyarlılığı düşük, 24.saat bakılan Cystatin C ise erken tanıda güçlü tanısal değere sahiptir. Postoperatif Cystatin C düzeyi ABH tanısında (özellikle 24.saatte) önemli katkı sağlayabilir.

Keywords

Kardiyak Cerrahi, Akut Böbrek Yetmezliği, Cystatin C, Kreatinin

Supporting Institution

Yok

Project Number

Yok

Thanks

Yok

THE RELATIONSHIP OF POSTOPERATIVE CYSTATIN C LEVEL WITH EARLY ACUTE RENAL FAILURE IN ADULT PATIENTS UNDERGOING CARDIAC SURGERY

Abstract

Introduction: Cardiovascular diseases are still the most important cause of mortality and morbidity in the world. Cardiac surgery is the most frequently performed major surgical intervention in hospitals, and acute kidney injury (AKI) that develops after surgery is an important condition that is frequently encountered and increases mortality. The success of treatment may be increased by early detection of AKI that may appear following surgery. In this study, we sought to assess how early stage acute renal failure and postoperative Cystatin C levels related in patients underwent cardiac surgery.
Methods: 40 adult patients over the age of 18 who underwent cardiac surgery between 2016 and 2017 participated in our study. All of the participants had baseline renal function that was normal (creatinine 1.2 mg/dL). The patients' baseline biochemistry values and demographics were noted. The link between postoperative AKI and plasma cystatin C level was examined using samples collected at 6 hours and 24 hours.
Results: In our study, 12 out of 40 patients were diagnosed with AKI according to the Akut Kidney Injury Network (AKIN) classification and 14 according to the Risk-Injury-Failure-Loss-End stage (RIFLE) classification.It was determined that the duration of hospital stay increased significantly with the development of AKI, the 24th hour Cystatin C level was correlated with the development of AKI (p:0.048) and was significantly higher in the group developing AKI. Presence of baseline diabetes was significantly higher in patients who developed AKI (p:0.045). Plasma Cystatin C 24-hour AUCROC value was calculated as 0.78 (0.75-0.90 Confidence interval, p:0.002). There was no correlation between Cystatin C level measured at 6th hour and AKI (p:0.358).
Conclusion: The development of AKI after cardiac surgery is associated with the frequency of adverse clinical events. Cystatin C tested at 6 hours has low sensitivity in early diagnosis, while Cystatin C at 24 hours has a strong diagnostic value in early diagnosis. Postoperative Cystatin C level can make a significant contribution to the diagnosis of AKI (especially at the 24th hour).

Keywords

Cardiac Surgery, Acute Renal Failure, Cystatin C, Creatinine

Project Number

Yok

References

• 1. Mensah GA, Roth GA, Fuster V. The Global Burden of Cardiovascular Diseases and Risk Factors: 2020 and Beyond. J Am Coll Cardiol.. 2019; 74:2529-32.
• 2. Amini M, Zayeri F, Salehi M. Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017. BMC Public Health.. 2021;21:1–12.
• 3. Brown JC, Gerhardt TE, Kwon E. Risk Factors for Coronary Artery Disease. Risk Factors in Coronary Artery Disease [Internet]. 2023 Jan 23 [cited 2023 Aug 14];1–219. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554410/
• 4. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology [Internet]. 2011 [cited 2023 Aug 14];114(4):964–70.
• 5. Thakar C V., Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int [Internet]. 2005 [cited 2023 Aug 14];67(3):1112–9.
• 6. Mishra J, Dent C, Tarabishi R, et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet [Internet]. 2005; 365(9466):1231-8.
• 7. Mehta RH, Grab JD, O’Brien SM, Bridges CR, Gammie JS, Haan CK, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation [Internet]. 2006 Nov [cited 2023 Aug 14];114(21):2208–16.
• 8. Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant [Internet]. 1999 [cited 2023 Aug 15];14(5):1158–62.
• 9. Chertow GM. Independent association between acute renal failure and mortality following cardiac surgery. American Journal of Medicine [Internet]. 1998 [cited 2023 Aug 15];104(4):343–8.
• 10. Y K. Acute kidney injury: current concepts and new insights. J Inj Violence Res [Internet]. 2016 Jan 1 [cited 2023 Aug 15];8(1).
• 11. Chertow GM. Independent association between acute renal failure and mortality following cardiac surgery. American Journal of Medicine [Internet]. 1998 [cited 2023 Aug 15];104(4):343-8.
• 12. Krawczeski CD, Vandevoorde RG, Kathman T, Bennett MR, Woo JG, Wang Y, et al. Serum Cystatin C Is an Early Predictive Biomarker of Acute Kidney Injury after Pediatric Cardiopulmonary Bypass. Clin J Am Soc Nephrol [Internet]. 2010 Sep 1 [cited 2023 Aug 15];5(9):1552.
• 13. Bellomo R, Kellum JA, Ronco C. Defining acute renal failure: physiological principles. Intensive Care Med [Internet]. 2004 Jan [cited 2023 Aug 15];30(1):33-7.
• 14. Pickering JW, James MT, Palmer SC. Acute kidney injury and prognosis after cardiopulmonary bypass: a meta-analysis of cohort studies. Am J Kidney Dis [Internet]. 2015 Feb 1 [cited 2023 Aug 15];65(2):283-93.
• 15. Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Dragun D, et al. Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery-a prospective cohort study. Crit Care Med [Internet]. 2009 [cited 2023 Aug 15];37(2):553-60.