Introduction
Materials and methods
Patient population
Outcomes
Sampling and measurement of renal function markers
Data collection
Statistical analysis
Results
Characteristics | AKI (n = 20) | No AKI (n = 80) | P value |
---|---|---|---|
Demographic data | |||
Age, years | 75.3 ± 4.1 | 68.1 ± 9.7 | <0.001 |
Female, number (percentage) | 6 (30.0) | 33 (41.0) | 0.36 |
Body mass index | 29.7 ± 4.3 | 27.4 ± 4.5 | 0.045 |
Comorbidities | |||
Preoperative serum creatinine, μmol/L | 96.1 ± 31.6 | 89.4 ± 24.0 | 0.30 |
Preoperative estimated glomerular filtration rate < 60 mL/minute, number (percentage) | 8 (40.0) | 19 (23.8) | 0.14 |
Left ventricular dysfunction (ejection fraction < 40%), number (percentage) | 7 (35.0) | 18 (22.5) | 0.25 |
Arterial hypertension, number (percentage) | 20 (100.0) | 64 (80.0) | 0.029 |
Hypercholesterolemia, number (percentage) | 16 (80.0) | 46 (57.5) | 0.06 |
Atrial fibrillation, number (percentage) | 10 (50.0) | 16 (20.0) | 0.006 |
Myocardial infarction (within 6 months preoperatively), number (percentage) | 7 (35.0) | 13 (16.3) | 0.06 |
Chronic obstructive pulmonary disease, number (percentage) | 6 (30.0) | 8 (10.0) | 0.021 |
Peripheral vascular disease, number (percentage) | 4 (20.0) | 2 (2.5) | 0.013 |
Diabetes mellitus, number (percentage)a | 8 (40.0) | 20 (25.0) | 0.18 |
Intervention | |||
Coronary artery bypass grafting surgery, number (percentage) | 7 (35.0) | 18 (22.5) | 0.25 |
Valvular surgery, number (percentage) | 7 (35.0) | 45 (56.3) | 0.09 |
Simultaneous coronary revascularisation and valve surgery, number (percentage) | 6 (30.0) | 11 (13.8) | 0.08 |
Duration of cardiopulmonary bypass (minutes) | 147.0 ± 31.6 | 136.0 ± 41.0 | 0.20 |
Fluid intake, 0–24 hours, mLb | 5,500 ± 1,900 | 5,150 ± 1,250 | 0.44 |
Urine output, 0–24 hours, mL | 3,350 ± 1,050 | 3,990 ± 1,500 | 0.034 |
Furosemide dose, 0–24 hours, mg | 133.9 ± 168.7 | 30.9 ± 34.8 | <0.001 |
Outcomes | |||
Need for renal replacement therapy or died during hospital stay, number (percentage) | 4 (20.0) | 1 (1.3) | 0.005 |
Ventilation, days | 2.4 ± 3.1 | 0.9 ± 0.8 | 0.010 |
Length of stay in the intensive care unit, days | 6.3 ± 7.1 | 2.3 ± 2.1 | 0.012 |
Length of stay in hospital, days | 16.2 ± 13.8 | 9.5 ± 4.7 | 0.026 |
Urinary IL-18 | AKI (n = 20) | No AKI (n = 80) | P value |
---|---|---|---|
Unadjusted values | |||
Preoperative, pg/mL | 0 (0–25) | 0 (0–44) | 0.28 |
On arrival in the intensive care unit, pg/mL | 168 (19–736) | 104 (36–292) | 0.70 |
At 24 hours postoperatively, pg/mL | 195 (54–537) | 165 (42–288) | 0.47 |
Values adjusted for urinary creatinine | |||
Preoperative, pg/mg | 0 (0–12) | 0 (0–32) | 0.32 |
On arrival in the intensive care unit, pg/mg | 332 (44–1,789) | 233 (86–531) | 0.57 |
At 24 hours postoperatively, pg/mg | 190 (75–478) | 124 (41–245) | 0.25 |
Variables | AUC-ROCC (95% CI) | P value |
---|---|---|
Increase in serum creatinine > 25% within 24 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.58 (0.46–0.71) | 0.19 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.56 (0.43–0.69) | 0.34 |
Increase in serum creatinine > 50% within 24 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.56 (0.38–0.74) | 0.51 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.57 (0.40–0.73) | 0.45 |
Increase in serum creatinine > 25% within 48 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.59 (0.47–0.71) | 0.14 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.56 (0.43–0.68) | 0.36 |
Increase in serum creatinine > 50% within 48 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.53 (0.38–0.68) | 0.70 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.55 (0.40–0.71) | 0.48 |
Increase in serum creatinine > 25% within 72 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.60 (0.39–0.71) | 0.63 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.58 (0.44–0.72) | 0.55 |
Increase in serum creatinine > 50% within 72 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.58 (0.36–0.66) | 0.85 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.55 (0.41–0.69) | 0.50 |
Increase in serum creatinine > 25% within 120 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.60 (0.48–0.72) | 0.10 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.59 (0.47–0.71) | 0.14 |
Increase in serum creatinine > 50% within 120 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.52 (0.38–0.67) | 0.78 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.56 (0.43–0.70) | 0.38 |
Variables | AUC-ROCC (95% CI) | P value |
---|---|---|
RIFLE R or worse (R: n = 31 + I: n = 13 + F: n = 6) | ||
Urinary IL-18 on arrival in the intensive care unit | 0.61 (0.48–0.74) | 0.12 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.57 (0.43–0.71) | 0.30 |
RIFLE I or worse (I: n = 13 + F: n = 6) | ||
Urinary IL-18 on arrival in the intensive care unit | 0.52 (0.38–0.68) | 0.35 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.58 (0.43–0.73) | 0.28 |
Variables | AUC-ROCC (95% CI) | P value |
---|---|---|
AKIN stage 1 or worse (n = 32) | ||
Urinary IL-18 on arrival in the intensive care unit | 0.48 (0.35–0.61) | 0.80 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.59 (0.46–0.72) | 0.15 |
Variables | AUC-ROCC (95% CI) | P value |
---|---|---|
Increase in serum creatinine > 25% within 48 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.58 (0.46–0.71) | 0.19 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.56 (0.43–0.69) | 0.43 |
Increase in serum creatinine > 50% within 48 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.56 (0.38–0.74) | 0.51 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.57 (0.40–0.73) | 0.45 |
Increase in serum creatinine > 25% within 120 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.59 (0.47–0.71) | 0.14 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.56 (0.43–0.68) | 0.36 |
Increase in serum creatinine > 50% within 120 hours postoperatively | ||
Urinary IL-18 on arrival in the intensive care unit | 0.51 (0.34–0.67) | 0.93 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.57 (0.42–0.73) | 0.36 |
RIFLE R or worse (R: n = 31 + I: n = 13 + F: n = 6) | ||
Urinary IL-18 on arrival in the intensive care unit | 0.61 (0.48–0.74) | 0.12 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.57 (0.43–0.71) | 0.29 |
RIFLE I or worse (I: n = 13 + F: n = 6) | ||
Urinary IL-18 on arrival in the intensive care unit | 0.52 (0.37–0.67) | 0.30 |
Urinary IL-18 at 24 hours after cardiopulmonary bypass | 0.58 (0.43–0.73) | 0.28 |
Discussion
Conclusion
Key messages
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Urinary interleukin-18 (IL-18) measured on arrival in the intensive care unit and at 24 hours postoperatively does not predict acute kidney injury in adult cardiac surgical patients.
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Urinary IL-18 appears instead to be a marker of inflammation in this setting.