Combination Of Biomarker For Diagnosis Of Cardiac Suergery-Associated Acute Kidney Injury

Objective: To assessed the ability of these biomarkers alone and in combination to predict the patients who developed AKI which was defined by KDIGO guideline.Method: samples were obtained from 53 patients enrolled according the inclusion criteria and the exclusion criteria in the study. Operative data, including gender, age, operative time, intraoperative urinary output, clinic history and the history of medicine, was recorded. Samples of serum and urine were obtain per-operatively,6h,24 h,48h and 72 h after surgery, which were detect the concentration of serum creatinine, uNGAL, uKIM-1 and uCys C。AKI was defined using AKI criteria which proposed by Kidney Disease Improving Global Outcomes(KDIGO) guideline in 2012.Result: Off 53 patients, 21 patients(39.6) developed CSA-AKI. NGAL peaked 6h after surgery(P<0.05),whereas there is no significant difference compared with control group at 48 h after surgery(P>0.05). The concentration of KIM-1 reminded significantly increased at the time point of 24 h after surgery(P<0.05),and with the lapse of time, the concentration of it gradually decreased. However, it still reminded significantly difference compared with control group at the point of postoperative 72 h. The concentration of serum Cys C appeared to increase significantly in postoperative 24h(P<0.05),which keep the high value of concentration in the following time points. uNGAL is the best predictor(ROC-AUC=0.936) compared with the other two biomarkers at 6h after surgery. NGAL+ KIM-1, KIM-1+ Cys C and KIM-1 alone reminded the ability to diagnosis of CSA-AKI with a higher accuracy(AUC=0.978,0.983 and 0.975, respectively) compared the biomarkers including NGAL, Cys C and NGAL+ Cys C(AUC=0.764,0.701 and 0.880, respectively) at the time point of 24 h after operation.6. KIM-1+Cys C with the highest accuracy(AUC) is a predictor of CSA-AKI at postoperative 48 h compared with KIM-1 and Cys C alone(AUC=0.860 and 0.827,respectively).Conclusion: With the detection of different biomarkers and different time point, the ability to diagnosis of CSA-AKI varies. Combination of biomarker may provide a basis for the diagnosis of CSA-AKI.