Abstract: FR-PO122

Plasma Cytokines Are Associated with Increased AKI and 1-Year Mortality after Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States
  • Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States
  • Jia, Yaqi, Yale School of Medicine, New Haven, Connecticut, United States
  • Thiessen Philbrook, Heather, Yale School of Medicine, New Haven, Connecticut, United States
  • Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
  • Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
  • Shlipak, Michael, San Francisco VA Medical Center, San Francisco, California, United States

Group or Team Name

  • TRIBE-AKI
Background

Inflammatory pathways are activated in ischemia reperfusion injury (IRI) and their decreases IRI-related acute kidney injury (AKI) and improves survival in animal models. However, the significance of these pathways in humans is unknown

Methods

In the TRIBE-AKI cohort of high-risk adults who underwent cardiac surgery (n=1444), we measured 10 inflammatory cytokines [interferon (IFN)-γ, tumor necrosis factor(TNF)-α, interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and IL-13] from plasma samples collected after cardiac surgery using Mesoscale multiplex assay. We tested the association of peak postoperative cytokine values with postoperative AKI Network stage 1 AKI and 1-year mortality

Results

AKI occurred in 492 and 1-year mortality in 81 participants. Higher cytokine levels were independently associated with increased odds of AKI and 1-year mortality for 10 cytokines in the model adjusted for 14 key variables (Figure). After further adjustment for IL-6, only IL-2, IL-8 and IL-10 remained significantly associated with 1-year mortality, and IL-10 with AKI. Given that cytokines in the multiplex were highly collinear, we performed principal component analysis to combine these cytokines. Adding the principal components to the clinical model consisting of the above 14 variables improved the AUC by 0.01 (P<0.001) for AKI and 0.04 (P<0.001) for 1-year mortality resulting in final AUCs of 0.77 (0.75, 0.80) and 0.76 (0.70, 0.82), respectively

Conclusion

Combination of inflammatory cytokines measured using a multiplex assay after cardiac surgery provided higher discrimination for AKI and 1-year mortality as compared with the clinical model

Funding

  • NIDDK Support