The role of serum cystatin C level in detection of early onset kidney injury after coronary artery bypass surgery

Abstract

Aim: Acute kidney injury (AKI) is an important condition after coronary artery bypass graft (CABG) surgery. Precautions can be taken to prevent AKI by recognizing the risky patients in the preoperative period. In this study, we investigated the relationship between the serum cystatin C (CyC) levels and AKI after CABG surgery.
Methods: A total of 42 patients (mean age 59.33 (6.66) and 69% male) who underwent isolated on-pump CABG between June 2018 and January 2019 were included in this prospective cohort study. Creatinine and CyC levels were evaluated at the preoperative period, postoperative 2nd and 24th hours. Patients were assessed for the development of AKI according to the Acute Kidney Injury Network criteria and divided into two groups as those with and without AKI in the postoperative period.
Results: Based on the creatinine level at the postoperative 24th hour, 9 (21.4%) patients developed AKI. Compared to patients who did not develop AKI, it was found that CyC level was significantly higher at the postoperative 2nd hour in patients who developed AKI (1.06 (0.26) vs 0.87 (0.19), P=0.023). In patients who developed AKI, the duration of cross-clamp was significantly longer (P=0.038), and erythrocyte suspension (P<0.001) and the number of fresh frozen plasma infusions (P<0.001) were significantly higher.
Conclusion: Increased CyC levels were associated with the development of AKI in the early postoperative period. CyC measurements performed in the initial period after CABG can be used in the diagnosis of cardiac surgery related AKI.

Keywords

• Coronary artery bypass graft surgery
• Serum cystatin C
• Acute kidney injury

Koroner arter baypas cerrahisi sonrası erken dönemde gelişen böbrek hasarının saptanmasında serum sistatin C düzeyinin rolü

Öz

Amaç: Akut böbrek hasarı (AKI), koroner arter baypas greft (KABG) ameliyatından sonra gelişebilen önemli bir klinik durumdur. Preoperatif dönemde riskli hastaları tanıyarak AKI'nın önlenmesi için önlemler alınabilir. Bu nedenle, AKI için risk faktörlerini belirlemek çok önemlidir. Bu çalışmada, serum sistatin C (CyC) düzeyleri ile CABG cerrahisi sonrası gelişen AKI arasındaki ilişkiyi araştırdık.
Yöntemler: Haziran 2018-Ocak 2019 tarihleri arasında kardiyopulmoner bypass eşliğinde yapılan KABG cerrahisi yapılan toplam 42 hasta (ortalama yaş 59,33 (6,66) ve %69 erkek) bu prospektif kohort çalışmasına dahil edildi. Acut Kidney İnjury Network (AKİN) kriterlerine göre AKI gelişimi değerlendirildi. Hastalar postoperatif dönemde AKI olan ve olmayanlar olmak üzere iki gruba ayrıldı.
Bulgular: Postoperatif 24. saatte kreatinin düzeyine göre 9 (%21,4) hastada AKI gelişti. AKI gelişmeyen hastalarla karşılaştırıldığında, AKI gelişen hastalarda postoperatif 2. saatte CyC düzeyinin kreatinin düzeyine göre anlamlı derecede yüksek olduğu bulundu (1,06 (0,26) vs 0,87 (0,19), P=0,023). AKI gelişen hastalarda krosklemp süresi anlamlı olarak daha uzun (P=0,038), eritrosit süspansiyonu (P<0,001) ve taze donmuş plazma (P<0,001) kullanımı AKI gelişmeyen hastalardan anlamlı olarak daha yüksekti.
Sonuç: Artmış CyC düzeyleri, postoperatif erken dönemde AKI gelişimi ile ilişkili bulunmuştur. CABG sonrası erken dönemde yapılan CyC ölçümleri, kalp cerrahisi ile ilişkili AKI tanısında kullanılabilir.

Anahtar Kelimeler

• Koroner arter baypas greft cerrahisi
• Serum sistatin C
• Akut böbrek hasarı

References

1. 1. Özçelik Z, Askar FZ. Frequency and factors affecting the development of acute kidney injury following open heart surgery. J Surg Med. 2020;4(5):340-5.
2. 2. Rosner MH, Okusa MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol. 2006 Jan 1;(1):19-32.
3. 3. Karkouti K, Wijeysundera DN, Beattie WS. Reducing Bleeding in Cardiac Surgery (RBC) Investigators. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation. 2008;117:478-84.
4. 4. Machado MN, Nakazone MA, Maia LN. Prognostic value of acute kidney injury after cardiac surgery according to kidney disease: Improving global outcomes definition and staging (KDIGO) criteria. PLoS One. 2014;9:e98028.
5. 5. Erdolu B, Engin M. Can C-reactive protein to albumin ratio be used as a predictor of amputation development in acute lower extremity ischemia? J Surg Med. 2020;4(6):501-4.
6. 6. Çayır MÇ, Til A. The utility of mean platelet volume as a predictor of postoperative atrial fibrillation following coronary artery bypass grafting. J Surg Med. 2020;4(6):438-42.
7. 7. Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis. Am J Kidney Dis. 2002 Aug;40(2):221-6.
8. 8. Odutayo A, Cherney D. Cystatin C and acute changes in glomerular filtration rate. Clin Nephrol. 2012 Jul;78(1):64-75.

9. 9. Arun O, Celik G, Oc B, Unlu A, Celik JB, Oc M, et al. Renal effects of coronary artery bypass graft surgery in diabetic and non-diabetic patients: a study with urinary neutrophil gelatinase-associated lipocalin and serum cystatin C. Kidney Blood Press Res. 2015;40(2):141-52.
10. 10. Dardashti A, Nozohoor S, Algotsson L, Ederoth P, Bjursten H. The predictive value of s-cystatin C for mortality after coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2016 Jul;152(1):139-46.
11. 11. Klein SJ, Brandtner AK, Lehner GF, Ulmer H, Bagshaw SM, et al. Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Intensive Care Med. 2018;44:323-36.
12. 12. Wasén E, Isoaho R, Mattila K, Vahlberg T, Kivelä SL, Irjala K. Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum Cystatin C. J Intern Med. 2004;256(1):70-8.
13. 13. Fuhrman DY, Nguyen LG, Sanchez-de-Toledo J, Priyanka P, Kellum JA. Postoperative Acute Kidney Injury in Young Adults with Congenital Heart Disease. Ann Thorac Surg. 2019 May;107(5):1416-20.
14. 14. Ueno K, Seki S, Shiokawa N, Matsuba T, Miyazono A, Hazeki D, et al. Validation of acute kidney injury according to the modified KDIGO criteria in infant safter cardiac surgery for congenital heart disease. Nephrology (Carlton). 2019 Mar;24(3):294-300.
15. 15. Chew STH, Hwang NC. Acute Kidney Injury After Cardiac Surgery: A Narrative Review of the Literature. J Cardiothorac Vasc Anesth. 2019 Apr;33(4):1122-38.
16. 16. Ho J, Lucy M, Krokhin O, Hayglass K, Pascoe E, Darroch G, et al. Mass spectrometry-based proteomic analysis of urine in acute kidney injury following cardiopulmonary bypass: a nested case-control study. Am J Kidney Dis. 2009;53:584-95.
17. 17. Almac E, Ince C. The impact of storage on red cell function in blood transfusion. Best Pract Res Clin Anaesthesiol. 2007; 21:195-208.
18. 18. Comporti M, Signorini C, Buonocore G, Ciccoli L. Iron release, oxidative stress and erythrocyte ageing. Free Radic Biol Med. 2002;32:568-76.
19. 19. Hogman CF, Meryman HT. Storage parameters affecting red blood cell survival and function after transfusion. Transfus Med Rev. 1999;13:275-96.
20. 20. Donadee C, Raat NJ, Kanias T, Tejero J, Lee JS, Kelley EE, et al. Nitric oxide scavenging by red blood cell microparticles and cell-free hemoglobin as a mechanism for the red cell storage lesion. Circulation. 2011;124:465-76.
21. 21. Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, et al. Evolution of adverse changes in stored RBCs. Proc Natl Acad Sci. 2007;104:17063-8.
22. 22. Bosman GJ, Werre JM, Willekens FL, Novotny VM. Erythrocyte ageing in vivo and in vitro: structural aspects and implications for transfusion. Transfus Med. 2008;18:335-47.
23. 23. Bosman GJ, Lasonder E, Groenen-Dopp YA, Willekens FL, Werre JM, Novotny VM. Comparative proteomics of erythrocyte aging in vivo and in vitro. J Proteomics. 2010;73:396-402.
24. 24. Luten M, Roerdinkholder-Stoelwinder B, Schaap NP, de Grip WJ, Bos HJ, Bosman GJ. Survival of red blood cells after transfusion: a comparison between red cells concentrates of different storage periods. Transfusion. 2008;48:1478-85.
25. 25. Mazer CD, Whitlock RP, Fergusson DA, Hall J, Belley-Cote E, Connolly K, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med. 2017;377:2133-44.
26. 26. Chen QH, Wang HL, Liu L, Shao J, Yu J, Zheng RQ. Effects of restrictive red blood cell transfusion on the prognoses of adult patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Crit Care. 2018 May 31;22(1):142.
27. 27. Stover EP, Siegel LC, Parks R, Levin J, Body SC, Maddi R, et al. Variability in transfusion practice for coronary artery bypass surgery persists despite national consensus guidelines: a 24-institution study. Institutions of the Multicenter Study of Perioperative Ischemia Research Group. Anesthesiology. 1998 Feb;88(2):327-33.
28. 28. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, et al. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med. 2006;34:1608-16.
29. 29. Güven CY, Aksun M, Karahan N, Girgin S, Kuru V, Golboyu BE, et al. Koroner Arter Baypas Greftleme (KABG) Cerrahisi Geçiren Hastalarda Kan ve Kan Ürünü Transfüzyonunun Postoperatif Komplikasyonlar Üzerine Olan Etkileri. GKDA Derg. 2015;21(2):101-10.