PDF(Pubmed)
Abstract：
BACKGROUND: The development of acute kidney injury (AKI) post-cardiac surgery significantly increases patient morbidity and healthcare costs. Prior researches have established Syndecan-1 (SDC-1) as a potential biomarker for endothelial injury and subsequent acute kidney injury development. This study assessed whether postoperative SDC-1 levels could further predict AKI requiring kidney replacement therapy (AKI-KRT) and AKI progression.
METHODS: In this prospective study, 122 adult cardiac surgery patients, who underwent valve or coronary artery bypass grafting (CABG) or a combination thereof and developed AKI within 48 h post-operation from May to September 2021, were monitored for the progression to stage 2-3 AKI or the need for KRT. We analyzed the predictive value of postoperative serum SDC-1 levels in relation to multiple endpoints.
RESULTS: In the study population, 110 patients (90.2%) underwent cardiopulmonary bypass, of which thirty received CABG or combined surgery. Fifteen patients (12.3%) required KRT, and thirty-eight (31.1%) developed progressive AKI, underscoring the severe AKI incidence. Multivariate logistic regression indicated that elevated SDC-1 levels were independent risk factors for progressive AKI (OR = 1.006) and AKI-KRT (OR = 1.011). The AUROC for SDC-1 levels in predicting AKI-KRT and AKI progression was 0.892 and 0.73, respectively, outperforming the inflammatory cytokines. Linear regression revealed a positive correlation between SDC-1 levels and both hospital (β = 0.014, p = 0.022) and ICU stays (β = 0.013, p < 0.001).
CONCLUSIONS: Elevated postoperative SDC-1 levels significantly predict AKI progression and AKI-KRT in patients following cardiac surgery. The study\'s findings support incorporating SDC-1 level monitoring into post-surgical care to improve early detection and intervention for severe AKI.
METHODS: In this prospective study, 122 adult cardiac surgery patients, who underwent valve or coronary artery bypass grafting (CABG) or a combination thereof and developed AKI within 48 h post-operation from May to September 2021, were monitored for the progression to stage 2-3 AKI or the need for KRT. We analyzed the predictive value of postoperative serum SDC-1 levels in relation to multiple endpoints.
RESULTS: In the study population, 110 patients (90.2%) underwent cardiopulmonary bypass, of which thirty received CABG or combined surgery. Fifteen patients (12.3%) required KRT, and thirty-eight (31.1%) developed progressive AKI, underscoring the severe AKI incidence. Multivariate logistic regression indicated that elevated SDC-1 levels were independent risk factors for progressive AKI (OR = 1.006) and AKI-KRT (OR = 1.011). The AUROC for SDC-1 levels in predicting AKI-KRT and AKI progression was 0.892 and 0.73, respectively, outperforming the inflammatory cytokines. Linear regression revealed a positive correlation between SDC-1 levels and both hospital (β = 0.014, p = 0.022) and ICU stays (β = 0.013, p < 0.001).
CONCLUSIONS: Elevated postoperative SDC-1 levels significantly predict AKI progression and AKI-KRT in patients following cardiac surgery. The study\'s findings support incorporating SDC-1 level monitoring into post-surgical care to improve early detection and intervention for severe AKI.
摘要：
背景：心脏手术后急性肾损伤（AKI）的发展显著增加了患者的发病率和医疗费用。先前的研究已经确立了Syndecan-1(SDC-1)作为内皮损伤和随后的急性肾损伤发展的潜在生物标志物。这项研究评估了术后SDC-1水平是否可以进一步预测需要肾脏替代疗法（AKI-KRT）和AKI进展的AKI。
方法：在这项前瞻性研究中，122名成人心脏手术患者，在2021年5月至9月期间接受了瓣膜或冠状动脉旁路移植术(CABG)或其组合并在术后48h内发生AKI的患者接受了监测进展至2~3期AKI或是否需要KRT.我们分析了术后血清SDC-1水平与多个终点的关系。
结果：在研究人群中，110例(90.2%)患者接受体外循环,其中30人接受了CABG或联合手术。15例患者（12.3%）需要KRT，三十八人(31.1%)发展为进行性AKI，强调严重的AKI发病率。多因素Logistic回归分析显示,SDC-1水平升高是AKI(OR=1.006)和AKI-KRT(OR=1.011)的独立危险因素。预测AKI-KRT和AKI进展的SDC-1水平的AUROC分别为0.892和0.73。优于炎性细胞因子。线性回归显示SDC-1水平与住院（β=0.014，p=0.022）和ICU住院时间（β=0.013，p<0.001）呈正相关。
结论：术后SDC-1水平升高可显著预测心脏手术后患者的AKI进展和AKI-KRT。研究结果支持将SDC-1水平监测纳入术后护理，以改善严重AKI的早期发现和干预。
方法：在这项前瞻性研究中，122名成人心脏手术患者，在2021年5月至9月期间接受了瓣膜或冠状动脉旁路移植术(CABG)或其组合并在术后48h内发生AKI的患者接受了监测进展至2~3期AKI或是否需要KRT.我们分析了术后血清SDC-1水平与多个终点的关系。
结果：在研究人群中，110例(90.2%)患者接受体外循环,其中30人接受了CABG或联合手术。15例患者（12.3%）需要KRT，三十八人(31.1%)发展为进行性AKI，强调严重的AKI发病率。多因素Logistic回归分析显示,SDC-1水平升高是AKI(OR=1.006)和AKI-KRT(OR=1.011)的独立危险因素。预测AKI-KRT和AKI进展的SDC-1水平的AUROC分别为0.892和0.73。优于炎性细胞因子。线性回归显示SDC-1水平与住院（β=0.014，p=0.022）和ICU住院时间（β=0.013，p<0.001）呈正相关。
结论：术后SDC-1水平升高可显著预测心脏手术后患者的AKI进展和AKI-KRT。研究结果支持将SDC-1水平监测纳入术后护理，以改善严重AKI的早期发现和干预。
