Abstract: SA-PO122
Intra-Operative Shedding of Endothelial Glycocalyx in Cardiac Surgery-Associated AKI: A Prospective Longitudinal Cohort
Session Information
- AKI: Biomarkers, Imaging, Interventions
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Joslin, Jennifer R., King's College London, London, United Kingdom
- Deshpande, Ranjit, Cardiothoracic Surgery, King's College Hospital, London, United Kingdom
- Griffiths, Kathryn, King's College London, London, United Kingdom
- Satchell, Simon C., University of Bristol, Bristol, Bristol, United Kingdom
- Sharpe, Claire C., King's Kidney Care, King's College Hospital, London, United Kingdom
- Bramham, Kate, King's College London, London, United Kingdom
Background
This novel study aimed to consider the temporal association between microvascular disruption and cardiac surgery-associated acute kidney injury (CSA-AKI) by investigating dynamic endothelial glycocalyx changes.
Methods
We conducted a prospective observational cohort study of 61 patients undergoing non-emergency coronary artery bypass graft (CABG) surgery with serial sampling at set time-points in the pre, intra and post-operative period. We measured plasma syndecan-1 (SDC1), a major endothelial glycocalyx structural component, and calculated a ratio against plasma albumin (SDC1:alb) to take account of intraoperative haemodilution fluctuations. CSA-AKI within 48 hours was assessed using Kidney Disease Improving Global Outcomes (KDIGO) criteria. Demographic, clinical and surgical variables were considered in analysis.
Results
14/61 (23.0%) participants developed CSA-AKI.
Peak intraoperative SDC1:alb and increase from baseline of peak SDC1:alb were significantly higher in participants who subsequently developed CSA-AKI compared to those who did not (P=0.0063; P=0.008). (Figure 1)
The best predictor variables of CSA-AKI were peak SDC1:alb (AUC 0.777) and urine protein:creatinine ratio (uPCR, AUC 0.840).
After adjusting for uPCR and other key variables, odds of CSA-AKI in patients with peak SDC1:alb greater than the derived optimal cut-off of 23 were 11 times those with a lower peak SDC1:alb (OR 11.0 (95% CI 1.57- 106.91, P=0.021)).
Conclusion
This is the first demonstration of increased intraoperative shedding of SDC1, a core endothelial glycocalyx constituent, in CABG patients who subsequently developed CSA-AKI. These findings suggest endothelial glycocalyx disruption and microvascular dysfunction in CSA-AKI may provide a target for early therapeutic intervention and / or facilitate earlier identification of patients at greatest risk.