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Abstract: TH-PO113

Serum α1-Antitrypsin Predicts Severe AKI After Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Ai, Jun, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
  • Xiao, Zhiwen, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
  • Tian, Jianwei, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
Background

Human α1-antitrypsin (A1AT), a binding protein with affinity to hemin, is an acute phase glycoprotein with broad anti-inflammatory properties. It is involved in the pathophysiologic processes underlying ischemic AKI and could exert dramatic renoprotective effects. Our objective is to assess the ability of serum A1AT (sA1AT) to predict AKI in adults undergoing heart surgery.

Methods

We conducted a prospective, single-center, cohort study in 201 patients undergoing cardiac surgery in our center since 1st July to 31st December 2017. We analyzed levels of sA1AT and other injury biomarkers during the perioperative period.Severe AKI was defined as Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or 3. Overall AKI was defined as KDIGO stage 1.

Results

Of the 201 patients entered the final analysis, 69 (34.3%) developed mild AKI, and 22 (10.9%) developed severe AKI. sA1AT level increased immediately 1h after operation, maintained at the peak for 12 hours, and subsequently decreased in patients who developed severe AKI. After multivariate adjustment, sA1AT 1h after CPB independently associated with the development of severe AKI (OR, 1.46; 95% CI, 1.10-1.95; P=0.009) compared with mild AKI and no AKI, and the highest quartile of sMMP-7 level associated with 23-fold higher odds of severe AKI compared with the lowest quartile. For predicting severe AKI, sA1AT had an area under the receiver operating characteristic curve of 0.814, outperforming uTIM-1 and the clinical model. Elevated sA1AT level associated with longer stay in the intensive care unit and hospital.

Conclusion

sA1AT is a valuable potential predictor for severe AKI and poor in-hospital outcomes in patients after cardiac surgery.