The association of albumin/creatinine ratio with postoperative AKI in children undergoing cardiac surgery

Michael Zappitelli, Steven G. Coca, Amit X. Garg, Catherine D. Krawczeski, Heather Thiessen Philbrook, Kyaw Sint, Simon Li, Chirag Parikh, Prasad Devarajan

Research output: Contribution to journalArticle

Abstract

Background and objectives This study determined if preoperative and postoperative urine albumin/creatinine ratios (ACRs) predict postoperative AKI in children undergoing cardiac surgery (CS). Design, setting, participants, & measurements This was a three-center, prospective study (2007-2009) of 294 children undergoing CS (n=145 aged <2 years). Urine ACR was measured preoperatively and 0-6 hours after intensive care unit arrival. AKI outcomes were based on the Acute Kidney Injury Network serum creatinine (SCr) criteria (stage 1 AKI, ≥50% or 0.3 mg/dl SCr rise from baseline; and stage 2 or worse AKI, ≥SCr doubling or dialysis). AKI was predicted using preoperative and postoperative ACRs and postoperative ACR performance was compared with other AKI biomarkers. Results Preoperative ACR did not predict AKI in younger or older children. In children aged <2 years, first postoperative ACR ≥908 mg/g (103 mg/mmol) predicted stage 2 AKI development (adjusted relative risk, 3.4; 95% confidence interval, 1.2-9.4). In children aged ≥2 years, postoperative ACR ≥169 mg/g (19.1 mg/mmol) predicted stage 1 AKI (adjusted relative risk, 2.1; 95% confidence interval, 1.1-4.1). In children aged ≥2 years, first postoperative ACR improved AKI prediction from other biomarker and clinical prediction models, estimated by net reclassification improvement (P≤0.03), but only when serum cystatin C was also included in the model. Conclusions Postoperative ACR is a readily available early diagnostic test for AKI after pediatric CS that performs similarly to other AKI biomarkers; however, its use is enhanced in children aged ≥2 years and in combination with serum cystatin C.

Original languageEnglish (US)
Pages (from-to)1761-1769
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number11
DOIs
StatePublished - Nov 7 2012

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Thoracic Surgery
Albumins
Creatinine
Cystatin C
Serum
Biomarkers
Urine
Confidence Intervals
Routine Diagnostic Tests
Acute Kidney Injury
Intensive Care Units
Dialysis
Prospective Studies
Pediatrics

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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The association of albumin/creatinine ratio with postoperative AKI in children undergoing cardiac surgery. / Zappitelli, Michael; Coca, Steven G.; Garg, Amit X.; Krawczeski, Catherine D.; Thiessen Philbrook, Heather; Sint, Kyaw; Li, Simon; Parikh, Chirag; Devarajan, Prasad.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 11, 07.11.2012, p. 1761-1769.

Research output: Contribution to journalArticle

Zappitelli, Michael ; Coca, Steven G. ; Garg, Amit X. ; Krawczeski, Catherine D. ; Thiessen Philbrook, Heather ; Sint, Kyaw ; Li, Simon ; Parikh, Chirag ; Devarajan, Prasad. / The association of albumin/creatinine ratio with postoperative AKI in children undergoing cardiac surgery. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 11. pp. 1761-1769.
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abstract = "Background and objectives This study determined if preoperative and postoperative urine albumin/creatinine ratios (ACRs) predict postoperative AKI in children undergoing cardiac surgery (CS). Design, setting, participants, & measurements This was a three-center, prospective study (2007-2009) of 294 children undergoing CS (n=145 aged <2 years). Urine ACR was measured preoperatively and 0-6 hours after intensive care unit arrival. AKI outcomes were based on the Acute Kidney Injury Network serum creatinine (SCr) criteria (stage 1 AKI, ≥50{\%} or 0.3 mg/dl SCr rise from baseline; and stage 2 or worse AKI, ≥SCr doubling or dialysis). AKI was predicted using preoperative and postoperative ACRs and postoperative ACR performance was compared with other AKI biomarkers. Results Preoperative ACR did not predict AKI in younger or older children. In children aged <2 years, first postoperative ACR ≥908 mg/g (103 mg/mmol) predicted stage 2 AKI development (adjusted relative risk, 3.4; 95{\%} confidence interval, 1.2-9.4). In children aged ≥2 years, postoperative ACR ≥169 mg/g (19.1 mg/mmol) predicted stage 1 AKI (adjusted relative risk, 2.1; 95{\%} confidence interval, 1.1-4.1). In children aged ≥2 years, first postoperative ACR improved AKI prediction from other biomarker and clinical prediction models, estimated by net reclassification improvement (P≤0.03), but only when serum cystatin C was also included in the model. Conclusions Postoperative ACR is a readily available early diagnostic test for AKI after pediatric CS that performs similarly to other AKI biomarkers; however, its use is enhanced in children aged ≥2 years and in combination with serum cystatin C.",
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AU - Li, Simon

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AB - Background and objectives This study determined if preoperative and postoperative urine albumin/creatinine ratios (ACRs) predict postoperative AKI in children undergoing cardiac surgery (CS). Design, setting, participants, & measurements This was a three-center, prospective study (2007-2009) of 294 children undergoing CS (n=145 aged <2 years). Urine ACR was measured preoperatively and 0-6 hours after intensive care unit arrival. AKI outcomes were based on the Acute Kidney Injury Network serum creatinine (SCr) criteria (stage 1 AKI, ≥50% or 0.3 mg/dl SCr rise from baseline; and stage 2 or worse AKI, ≥SCr doubling or dialysis). AKI was predicted using preoperative and postoperative ACRs and postoperative ACR performance was compared with other AKI biomarkers. Results Preoperative ACR did not predict AKI in younger or older children. In children aged <2 years, first postoperative ACR ≥908 mg/g (103 mg/mmol) predicted stage 2 AKI development (adjusted relative risk, 3.4; 95% confidence interval, 1.2-9.4). In children aged ≥2 years, postoperative ACR ≥169 mg/g (19.1 mg/mmol) predicted stage 1 AKI (adjusted relative risk, 2.1; 95% confidence interval, 1.1-4.1). In children aged ≥2 years, first postoperative ACR improved AKI prediction from other biomarker and clinical prediction models, estimated by net reclassification improvement (P≤0.03), but only when serum cystatin C was also included in the model. Conclusions Postoperative ACR is a readily available early diagnostic test for AKI after pediatric CS that performs similarly to other AKI biomarkers; however, its use is enhanced in children aged ≥2 years and in combination with serum cystatin C.

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