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Cystatin C : influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery

Vassalos, Antony and Young, David and MacArthur, Kenneth and Pollock, James and Lyall, Fiona and Danton, Mark H.D. (2011) Cystatin C : influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery. Pediatric Anesthesia, 21 (12). pp. 1185-1191. ISSN 1155-5645

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Abstract

Background: Cardiopulmonary bypass (CPB)-associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR). Aim: We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery. Methods: Twenty children, aged 4-58 months (AVSD, n = 7; VSD, n = 9; and ASD, n = 4), were prospectively studied. Glomerular filtration rate was quantified postoperatively by creatinine clearance (first and second 12-h periods; CrCl 0-12 and CrCl 12-24). Serum cystatin C and Cr were measured preoperatively and on days 0-3. Recorded CPB parameters included bypass duration (BP), perfusion pressure (PP), lowest pump flow (Q min), lowest hematocrit, and corresponding lowest oxygen delivery (DO 2 min). Myocardial injury was determined by troponin-I. Results: Postoperatively, GFR remained unchanged (CrCl 0-12 63.6 ± 37.0 vs CrCl 12-24 65.1 ± 27.5; P = 0.51) and only correlated with cystatin C (CrCl 0-12 vs cystatin C Day0 [r = 0.58, P = 0.018] and Cr Day0 [r = 0.09, P = 0.735]). Cr and cystatin C increased postoperatively to peak on days 2 and 3, respectively (Cr PreOp 31 ± 6.9 vs Cr Day2 36.9 ± 12.2, P = 0.03; cystatin C Day0 0.83 ± 0.27 vs cystatin C Day3 1.45 ± 0.53, P = 0.02). Increased cystatin C was significantly associated with BP (P = 0.001), mean PP (P = 0.029), Q min (P = 0.005), troponin-I (P < 0.001), and DO 2min <300 ml·min -1·m -2 (P = 0.007). Receiver-operator cutoff >1.044 mg·l -1 for cystatin C exhibited 100% sensitivity and 67% specificity for detecting renal dysfunction, defined as GFR <55 ml·min -1·1.73 m -2. Conclusions: Cystatin C is a sensitive marker of early renal dysfunction following pediatric heart surgery. Variations in bypass parameters, myocardial injury, and ultimately critical oxygen delivery are significantly associated with the degree of renal impairment.