Kidney Week

Abstract: FR-PO073

Ouabain as an Early Marker of AKI

Session Information

• AKI: Epidemiology, Risk Factors, Prevention
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

• Cocchini, Lorenzo, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy

Lorenzo Cocchini,

• De Filippo, Marta, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy

Marta De Filippo,

• Marcello, Matteo, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy

Matteo Marcello,

• Raimondo, Davide, Universita Vita Salute San Raffaele, Milano, Lombardia, Italy

Davide Raimondo,

• Lanzani, Chiara, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Chiara Lanzani,

• Messaggio, Elisabetta, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Elisabetta Messaggio,

• Citterio, Lorena, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Lorena Citterio,

• Zagato, Laura, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Laura Zagato,

• Vezzoli, Giuseppe, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Giuseppe Vezzoli,

• Manunta, Paolo, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Paolo Manunta,

• Simonini, Marco, IRCCS Ospedale San Raffaele, Milano, Lombardia, Italy

Marco Simonini,

Background

Acute kidney injury (AKI) is a common post-cardiac surgery complication and its influence on morbidity and mortality makes it necessary to identify new preoperative biomarkers and solid predictive models for AKI. This study was designed to create a new powerful score for postoperative AKI risk and to validate the use of endogenous ouabain (EO) as biomarker of individual susceptibility for AKI after cardiac surgery.

Methods

1174 patients undergoing elective cardiac surgery were enrolled in the study and included in the analysis. The primary outcome was AKI development, according to KDIGO 2012 guidelines. Preoperative blood samples were collected to evaluate EO basal levels. Different preoperative clinical variables were analyzed, among which classic anthropometric variables, comorbidity and surgery-connected variables.

Results

AKI was developed in 21.6% of patients (9% developed severe AKI, stage ≥ 2), and it is significantly correlated to postoperative death and to preoperative EO levels in plasma (p-value < 0.001). Moreover the higher was EO level, the greatest was the incidence of AKI: the patients in the first EO tertile developed AKI with a frequency of 14.1%, 18.0% in the second tertile, and 28.8% in the third one. A significant association was also found among EO and cardiac and kidney basal function (EF and eGFR, p-value = 0.005 and p-value = 0.003, respectively). Five independent risk factors turned out to be significantly correlated to AKI and severe AKI: age, FE, NYHA class, reoperation and complex surgical intervention (p-value < 0.001 for all of them). In the light of these results, a clinical predictive model for AKI, based on the preoperative clinical values significantly associated with AKI and on the preoperative EO, was developed. The inclusion of EO in the predictive model led to a significant improvement in the prediction capacity of the score (AUC per Severe AKI = 0.82, 95% CI 0.771-0.858, p-value <0.001).

Conclusion

In conclusion, AKI is correlated to high postoperative mortality. EO preoperative level in plasma is strongly associated to cardiac and kidney basal function and a prediction score that includes it results in better patient stratification and more effective pre-operative counseling.