Work

The clinical outcomes of acute kidney injury substages based on serum cystatin C in pediatric patients undergoing cardiac surgery

Year: 2025

Type: article

Abstract: BACKGROUND: Multiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). The combination of biomarkers with conventional criteria to define AKI substages in order to identify high-risk patients and improve diagnostic accuracy was recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether AKI substages diagnosed with combined CysC criteria were associated with worse outcomes. METHODS: We prospectively included 2519 pediatric patients (<16 years) undergoing cardiac surgery with cardiopulmonary bypass (CPB) in our cohort between March 2022 and February 2023 in Fuwai Hospital. Demographic and clinical variables were collected. To define AKI substages, Kidney Disease: Improving Global Outcomes AKI definition (based on serum creatinine (SCr) or CysC) was used. The association between AKI exposure and outcomes including length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), length of hospital stay (LOHS), and 30-day mortality was assessed. In addition, we determined areas under the receiver operating characteristic (ROC) curve and cutoff value of CysC preoperatively and postoperatively to predict AKI. RESULTS: < .001), with cutoff point at 1.29 mg/dL (specificity, 0.77; sensitivity, 0.71). CONCLUSIONS: Our analysis indicates defining AKI with both CysC and SCr might more significantly affect clinical outcome associations in pediatric patients undergoing cardiac surgery. Moreover, the serum CysC cutoff of 1.29 mg/dL postoperatively is a valuable threshold for AKI risk assessment to define AKI subtypes.

Source: Renal Failure

DOI: 10.1080/0886022x.2025.2466114