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Abstract: SA-PO468

Novel Cardiac Biomarkers for AKI Risk Stratification After Pediatric Cardiac Surgery

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Greenberg, Jason Henry, Yale University , New Haven, Connecticut, United States
  • Parsons, Michael R., Johns Hopkins, Baltimore, Maryland, United States
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  • Jia, Yaqi, Yale University, New Haven, Connecticut, United States
  • Thiessen Philbrook, Heather, Yale University, New Haven, Connecticut, United States
  • Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Everett, Allen D., Johns Hopkins School of Medicine, Baltimore, Maryland, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Group or Team Name

  • TRIBE-AKI
Background

Children undergoing cardiac surgery are at high risk for postoperative AKI. Novel biomarkers are needed to improve risk stratification of AKI with consideration given to changes in physiology and biomarker distribution throughout childhood.

Methods

We enrolled children from 1 month to 18 years old, undergoing cardiopulmonary bypass. Plasma ST2, galectin-3, and NTproBNP, three FDA approved biomarkers of cardiac stretch or fibrosis, were measured preoperatively and postoperatively on day 1, within 6 hours of cardiac surgery.

Results

Postoperatively, AKI, defined by a doubling of baseline serum creatinine or dialysis, was diagnosed in 79/395 (29%) children. NTproBNP was the only biomarker in the preoperative period that was significantly different between patients with vs without AKI (median 0.7 [0.3, 2.9] vs. median 0.4 [0.2, 1.1]). First post-operative ST2, galectin-3, and NTproBNP were significantly higher in patients with vs. without AKI (ST2: median 21.2 [9.7, 74.0] vs 7.7 [3.8, 24.2] (p<0.001), galectin-3: median 16.4 [10.6, 21.0] vs 13.3 [9.4, 17.9], NTproBNP: median 1.3 [0.7, 6.5] vs. 0.6 [0.2, 2.2). A significant interaction between biomarker and age was present for both galectin-3 and NTproBNP (p<0.05). In children ≥2 years old, after multivariable adjustment, the highest tertile of preoperative galectin-3 and NTproBNP as well as day 1 ST2, galectin-3, and NTproBNP were associated with AKI (Table 1).

Conclusion

Novel cardiac biomarkers, particularly ST2 measured within 6 hours of cardiac surgery, can be used for risk stratification of AKI. The performance of biomarkers after cardiac surgery is affected by age and additional research is required to develop novel cardiac biomarkers for children less than 2 years old.

Funding

  • NIDDK Support