Abstract
BACKGROUND: Acute Kidney Injury (AKI) is a frequent post-operative complication following cardiac surgery in the clinical setting. Iron metabolism disorders are a key cause of kidney injury during the ischemia-reperfusion (IR) process. However, the role of iron metabolites in prediction of AKI remains unidentified. This study investigates the roles of iron metabolites ferritin, transferrin, and hepcidin in prediction of the occurrence and severity of AKI in children following cardiac surgery. METHODS: Serum and urine samples were collected from 219 children with the age from 1 to 36 months undergoing cardiopulmonary bypass (CPB), both preoperatively and postoperatively at 0 h and 6 h. Serum ferritin, urinary transferrin, and urinary hepcidin levels were measured. RESULTS: Among the included 219 children, 66 developed AKI postoperatively. Serum ferritin, urinary transferrin, and urinary hepcidin were significantly associated with the occurrence of AKI after CPB. The area under the receiver operating characteristic curve (AUC) for serum ferritin and urinary transferrin at 6 h postoperatively, and hepcidin at 0 h postoperatively achieved optimal values (serum ferritin AUC:0.804; urinary transferrin AUC:0.805; urinary hepcidin AUC:0.894). The combined analysis of the three biomarkers yielded a higher AUC than individual biomarkers alone. The combined biomarker panel demonstrated favourable predictive performance across all AKI severity stages. CONCLUSIONS: Ferritin, transferrin, and hepcidin serve as early predictive markers for AKI associated with cardiac surgery in children and are independent predictors for postoperative AKI. These biomarkers exhibit a good early predictive capacity for the severity of AKI.