Volume: 13 Issue: 2
Year: 2025, Page: 73-84, Doi: https://doi.org/10.47799/pimr.1302.25.8
Received: May 29, 2025 Accepted: June 5, 2025 Published: July 22, 2025
Background: Acute kidney injury (AKI) following cardiac surgery with cardiopulmonary bypass (CPB) is relatively common and has serious implications for morbidity and mortality. This study aimed to compare the incidence, risk factors, and early detection of acute kidney injury in cardiac surgery patients involving CPB, using both conventional and novel biomarkers. Patients and Methods: A prospective, randomised, and clinical study was conducted after ethical approval and informed consent from sixty-four patients. Blood and urine samples were collected before and after anaesthesia. Serum creatinine (SCr), serum cystatin C (SCysC), and urine N-acetyl-β-D-glucosaminidase (uNAG) to indicate renal tubular damage were concurrently assayed. Results: The pre-to-post-op alterations between SCr (73.50 vs 72.50, p=0.166) and SCysC (51.69 vs 54.84, p=0.100) and the incidence of AKI by KDIGO and TRIBE were 9.4% and 18.8%, respectively. The statistically significant risk factors of postoperative AKI were high BMI, New York Heart Association (NYHA) Class > II, Left Ventricular Ejection Fraction (LVEF) < 35%, prolonged cardiopulmonary bypass time > 3 hrs, prolonged cross-clamp time, insulin-dependent diabetes, high baseline creatinine, and high Cleveland Risk Score. A binomial logistic regression was performed to ascertain the effects of the pre-op biochemical profile on the likelihood of AKI by SCr. The logistic regression model was statistically significant for SCysC. Increasing SCysC was associated with an increased likelihood of AKI by SCr. Conclusions: The incidences of acute kidney injury detected with SCysC were 18.8% compared to SCr of 9.4%, and a Kappa of 0.62 suggests moderate agreement between the SCr and SCysC AKI definitions. However, they could also result from non-renal influences on SCysC levels, such as inflammation due CPB or medication effects, highlighting both the strengths and limitations of this biomarker.
Keywords: Acute kidney injury, Cardiac surgery, Serum creatinine, Serum cystatin C, Urine N-acetyl-β-D-glucosaminidase
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©2025 (Sanjeev Singh) et al. This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Singh S, Mishra R, Deigheidy EM. Role of Conventional Biomarkers versus Novel Biomarkers in Detecting Perioperative Acute Kidney
Injury in Cardiac Surgery Patients. Perspectives in Medical Research. 2025;13(2):73-84 DOI: 10.47799/pimr.1302.25.8