Abstract
Acute Kidney Injury (AKI) in the context of right ventricular failure (RVF) is thought to be largely congestive in nature. This study assessed the utility of biomarkers high sensitivity cardiac troponin T (hs-cTnT), N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), and neutrophil gelatinase-associated lipocalin (NGAL) for prediction and early detection of congestive AKI (c-AKI) following cardiac surgery. This prospective nested case-control study recruited 350 consecutive patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. Cases were patients who developed (1) AKI (2) new or worsening RVF, or (3) c-AKI. Controls were patients free of these complications. Biomarker levels were measured at baseline after anesthesia induction and immediately postoperatively. Patients with c-AKI had increased mean duration of mechanical ventilation and length of stay in hospital and in the intensive care unit (p < 0.01). For prediction of c-AKI, baseline NT-proBNP yielded an area under the curve (AUC) of 0.74 (95% CI, 0.60⁻0.89). For early detection of c-AKI, postoperative NT-proBNP yielded an AUC of 0.78 (0.66⁻0.91), postoperative hs-cTnT yielded an AUC of 0.75 (0.58⁻0.92), and ∆hs-cTnT yielded an AUC of 0.80 (0.64⁻0.96). The addition of baseline creatinine to ∆hs-cTnT improved the AUC to 0.87 (0.76⁻0.99), and addition of diabetes improved the AUC to 0.93 (0.88⁻0.99). Δhs-cTnT alone, or in combination with baseline creatinine or diabetes, detects c-AKI with high accuracy following cardiac surgery.