Cystatin C: influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery

Vassalos, A., Young, D., MacArthur, K., Pollock, J., Lyall, F. and Danton, M.H.D. (2011) Cystatin C: influence of perfusion and myocardial injury on early (<24 h) renal function after pediatric cardiac surgery. Paediatric Anaesthesia, 21(12), pp. 1185-1191. (doi: 10.1111/j.1460-9592.2011.03654.x)

Abstract

<p><b>Background:</b> Cardiopulmonary bypass (CPB)-associated renal dysfunction following cardiac surgery is well recognized. In patients with renal disease, cystatin C has emerged as a new biomarker which in contrast to creatinine (Cr) is sensitive to minor changes in glomerular filtration rate (GFR).</p> <p><b>Aim:</b> We utilized cystatin C to investigate the association of CPB perfusion parameters with acute renal injury after pediatric cardiac surgery.</p> <p><b>Methods:</b> Twenty children, aged 4–58 months (AVSD, n = 7; VSD, n = 9; and ASD, n = 4), were prospectively studied. Glomerular filtration rate was quantified postoperatively by creatinine clearance (first and second 12-h periods; CrC1_0–12 and CrCl_12–24). Serum cystatin C and Cr were measured preoperatively and on days 0–3. Recorded CPB parameters included bypass duration (BP), perfusion pressure (PP), lowest pump flow (Q_min), lowest hematocrit, and corresponding lowest oxygen delivery (DO₂ min). Myocardial injury was determined by troponin-I.</p> <p><b>Results:</b> Postoperatively, GFR remained unchanged (CrCl_0–12 63.6 ± 37.0 vs CrCl_12–24 65.1 ± 27.5; P = 0.51) and only correlated with cystatin C (CrCl_0–12 vs cystatin C_Day0 [r = 0.58, P = 0.018] and Cr_Day0 [r = 0.09, P = 0.735]). Cr and cystatin C increased postoperatively to peak on days 2 and 3, respectively (Cr_PreOp 31 ± 6.9 vs Cr_Day2 36.9 ± 12.2, P = 0.03; cystatin C_Day0 0.83 ± 0.27 vs cystatin C_Day3 1.45 ± 0.53, P = 0.02). Increased cystatin C was significantly associated with BP (P = 0.001), mean PP (P = 0.029), Q_min (P = 0.005), troponin-I (P < 0.001), and DO2min <300 ml·min−1·m−2 (P = 0.007). Receiver–operator cutoff >1.044 mg·l−1 for cystatin C exhibited 100% sensitivity and 67% specificity for detecting renal dysfunction, defined as GFR <55 ml·min⁻¹·1.73 m⁻².</p> <p><b>Conclusions:</b> Cystatin C is a sensitive marker of early renal dysfunction following pediatric heart surgery. Variations in bypass parameters, myocardial injury, and ultimately critical oxygen delivery are significantly associated with the degree of renal impairment.</p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Danton, Professor Mark and Pollock, Mr James and Lyall, Professor Fiona and Young, Dr David
• Authors: Vassalos, A., Young, D., MacArthur, K., Pollock, J., Lyall, F., and Danton, M.H.D.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Paediatric Anaesthesia
• ISSN: 1155-5645
• ISSN (Online): 1460-9592