RENAL RESISTIVE INDEX VERSUS CELL CYCLE ARREST BIOMARKERS IN EARLY DETECTION OF CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY USING CARDIOPULMONARY BYPASS

RENAL RESISTIVE INDEX VERSUS CELL CYCLE ARREST BIOMARKERS IN EARLY DETECTION OF ACUTE KIDNEY INJURY

  • Mohamed Mostafa Abd Elhameed Mohamed Assistant Lecturer, Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University
  • Hesham Ahmad Fouad Ahmad Professor, Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Egypt
  • Said Mohamed Elmedany Ali Professor, Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University
  • Reham Abdel Haleem Abo Elwafa Assistant Professor, Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University
  • Kareem Mahmoud Fathi Ateba Lecturer, Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Alexandria University, Egypt
Keywords: CSA-AKI, RRI together with cell cycle arrest biomarkers

Abstract

Background: A common unfavorable consequence of heart surgeries is cardiac surgery associated acute kidney injury (CSA-AKI). Renal resistive index (RRI) and urinary TIMP-2 with IGFBP7 have been proposed as tools for early CSA-AKI detection.

Patients and Methods: 60 eligible patient’s members of the American Society of Anesthesiologists class II or III aged 18 to 75, possessing a Cleveland Clinic score of 0–5, based on evaluation and planned to have elective on-pump cardiac surgery. Assessing RRI and cell cycle arrest biomarkers' efficacy for early identification of AKI was the primary aim of study. The secondary aims intended to assess AKI severity also identify and correlate cut-off values of these biomarkers with the severity of AKI in addition to assess need for renal replacement treatment (RRT).

Results: Ten patients (17.2%) developed CSA-AKI. At end of surgery and 4 hours postoperative, patients with AKI exhibited significantly higher RRI in comparison with those without it (0.73 [0.63-0.76] ,0.72 [0.65-0.75] vs. 0.65 [0.56–0.69], 0.66 [0.57–0.70] P <0.001*). Best results were obtained with a cutoff value of 0.71 at 4 hours postoperatively, with 90% sensitivity and 100% specificity while the cutoff value of 0.72 yielded highest sensitivity (80%) and specificity (100%) at the end of the surgical process. As regard value of [TIMP-2]*[IGFBP7], it was considerably higher in AKI patients at 4 hours after CPB. (0.469, [0.215–0.760] vs. 0.269 [0.108–0.712] P = 0.009). For a cutoff value of 0.3 (ng/mL)2/1000, the best outcomes were attained in terms of sensitivity (70%) and specificity (91.67%).

Conclusion: RRI has better early diagnostic accuracy (98.28) than urinary  cell cycle arrest biomarkers (87.93) but both tools are promising for detect CSA-AKI

Published
2024-06-11
Issue
Vol 10 No 4 (2023): Vol. 10 No. 4 (2023) Volume 10 Issue 4
Section
Articles