Abstract: FR-PO072

Biomarkers for the Prediction of AKI Progression after Pediatric Cardiac Surgery

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States
  • Zappitelli, Michael, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada
  • Jia, Yaqi, Yale University, New Haven, Connecticut, United States
  • Thiessen Philbrook, Heather, Yale University, New Haven, Connecticut, United States
  • de Fontnouvelle, Christina Anne-Josiane, Yale University, New Haven, Connecticut, United States
  • Wilson, Francis Perry, Yale University, New Haven, Connecticut, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States
Background

The risk for adverse outcomes dramatically increase as children progress to higher stages of AKI. No reliable methods currently exist to predict AKI progression in hospitalized children.

Methods

The TRIBE-AKI pediatric study is a three-center prospective cohort of children, 1 month to 18 years old, undergoing cardiopulmonary bypass. Urine biomarkers of injury (neutrophil gelatinase–associated lipocalin (NGAL), interleukin (IL) 18 (IL-18), kidney injury molecule 1 (KIM-1), liver fatty acid binding protein (LFABP), albumin) and plasma biomarkers of inflammation (interferon (INF), IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, tumor necrosis factor alpha (TNF)) were measured on the first day of serum creatinine defined AKI. AKI progression was defined as a worsening of AKIN stage; from stage I to stage II or III, from stage II to III, or stage III at any time.

Results

408 children were enrolled, of which 176 (43%) were diagnosed with AKI. On the first day of AKI, Stage I, Stage II, and Stage III AKI was diagnosed in 145 (36%), 25 (6%), and 6 (1.4%) children, respectively. 28 (7%) children had AKI progression. On the first day of serum creatinine diagnosed AKI, 11/17 biomarkers were significantly higher in patients with AKI progression vs without (Table). Urine LFABP among injury biomarkers and plasma IL-8 among inflammatory biomarkers had the highest discrimination for AKI progression [optimism adjusted AUC 0.70 (95% CI:0.58-0.81) and 0.80 (95% CI:0.67-0.90), respectively].

Conclusion

Urine and plasma biomarkers predict AKI progression in children after cardiac surgery. If validated, these biomarkers could be used to improve clinical care and guide enrollment in therapeutic trials of AKI.

Funding

  • NIDDK Support