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The aim of this study was to identify and validate novel biomarkers including functional tests for detecting AKI, AKI progression and other poor outcomes.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is the second most common type of AKI after septic AKI and is associated with increased mortality and morbidity. The progression of AKI with multiple organ failure can result in poor outcomes. Several novel biomarkers for earlier detection of AKI, discrimination of etiologies, and prediction of outcomes were developed. However, the availability of these novel biomarkers may be limited by its expense or reimbursement issues in different countries. In present study, we conduct a large cohort to identify and validate novel biomarkers including functional tests for detecting AKI, AKI progression and other poor outcomes.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard care "bundle" | Other | The management for AKI patients were performed by implementing a standard care "bundle" suggested by the Kidney Disease Improving Global Outcome (KDIGO) guideline. |
| Measure | Description | Time Frame |
|---|---|---|
| AKI progression | worsening of KDIGO stage within 1 week (progressing from stage 1 to either stage 2 or stage 3, or from stage 2 to stage 3). Patients diagnosed with progressive or persisting stage 3 AKI (stage 3 AKI for >3 consecutive days) were classified as having AKI progression. If patients who presented with stage 3 AKI but not requiring RRT subsequently required dialysis or developing persist severe AKI or death within 7 days, this was considered progression. | 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| Mortality | Mortality at 30 days, 90 days and 365 days | 365 days |
| Receipt of renal replacement treatment | Patients received renal replacement treatment during hospital stay |
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Inclusion Criteria:
Exclusion Criteria:
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The incidence of cardiac surgery-associated AKI (CSA-AKI) varies from 5% to 42%. CSA-AKI is the second most common cause of AKI in the intensive care setting (after sepsis) and is independently associated with increased morbidity and mortality. Patients was diagnosed AKI by KDIGO criteria.
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| Name | Affiliation | Role |
|---|---|---|
| Zhe Luo, Professor | Fudan University | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zhongshan hospital, Fudan university | Shanghai | 200030 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39379672 | Derived | Su Y, Liu WJ, Zhao YF, Zhang YJ, Qiu Y, Lu ZH, Wang P, Lin S, Tu GW, Luo Z. Modified furosemide responsiveness index and biomarkers for AKI progression and prognosis: a prospective observational study. Ann Intensive Care. 2024 Oct 8;14(1):156. doi: 10.1186/s13613-024-01387-y. | |
| 38879493 | Derived | Su Y, Wang P, Hu Y, Liu WJ, Zhang YJ, Chen JQ, Deng YZ, Lin S, Qiu Y, Li JK, Chen C, Tu GW, Luo Z. AKI-Pro score for predicting progression to severe acute kidney injury or death in patients with early acute kidney injury after cardiac surgery. J Transl Med. 2024 Jun 16;22(1):571. doi: 10.1186/s12967-024-05279-4. |
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| ID | Term |
|---|---|
| D058186 | Acute Kidney Injury |
| D016638 | Critical Illness |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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Serial blood and urine samples for biomarker analysis were collected after surgery and then every 6 h in day 1 and then daily until discharge from ICU or for a maximum of 7 days, respectively. Plasma (EDTA), serum, and urine supernatants were frozen within 2 h of sample collection, stored at -80℃, and thawed immediately before analysis.
| 365 days |
| Major adverse kidney events | MAKE was defined as the composite of≥25% loss in estimated glomerular filtration rate (eGFR), dialysis, or death. Estimated GFR was calculated from serum creatinine using the MDRD equation | 365 days |
| Persistent AKI | Persistent AKI is characterized by the continuance of AKI by serum creatinine or urine output criteria (as defined by KDIGO) beyond 48h from AKI onset. | 90 days |
| Persist severe AKI | Persistent severe AKI was defined as follows: Patients with stage 3 AKI at enrollment required a persistence of 72 hours or more to meet the end point. Patients enrolled at stage 2 AKI required a progression to stage 3 within 48 hours and a persistence at stage 3 for 72 consecutive hours to be considered end point positive. Additionally, patients with severe AKI who failed to achieve 72 hours due to death or the initiation of RRT were considered end point positive. | 90 days |
| Length of stay in the ICU | Length of stay in the ICU | 90 days |
| Length of stay in the hospital | Length of stay in the hospital | 90 days |
| AKI progression to stage 3 | worsening of KDIGO stage to stage 3 within 1 week (progressing from stage 1 or stage 2 to stage 3). | 7 days |
| AKI occurrence at 3 days | AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. | 3 days |
| AKI occurrence at 7 days | AKI was defined based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. | 7 days |
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |