Dong L, et al. - In this study, researchers assessed the sequential patterns of biomarker elevation following pediatric cardiopulmonary bypass (CPB), as well as, their diagnostic accuracy for the prediction of acute kidney injury (AKI). Findings demonstrated that at the 2 and 6 h time points after pediatric CPB, while urine neutrophil gelatinase-associated lipocalin (NGAL) remained a superior stand-alone test, a panel of carefully selected biomarkers may prove optimal at later time points.

Methods

• Researchers assessed neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver type fatty-acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinase-2 (TIMP-2), and insulin-like growth factor binding protein 7 (IGFBP7) as predictors of AKI (≥50% increase in serum creatinine from baseline).
• They calculated areas under the receiver-operator characteristic curves (AUCs) for each biomarker and for various biomarker combinations at multiple time points after CPB.

Results

• Researchers assessed a total of 150 patients in this study.
• Of those, 50 patients developed AKI by 24 h after CPB, with an elevated NGAL concentration first noted at 2 h post-CPB, increases in IL-18, L-FABP, and the product of TIMP-2 and IGFBP7 first noted at 6 h, and an elevated KIM-1 level noted at 12 h.
• It was also noted that urine NGAL remained the marker with the highest predictive ability (AUC > 0.9) at each time point.
• Findings also demonstrated that predictive accuracy of NGAL alone at 2 and 6 h did not increase subsequent to the addition of any other biomarker.
• Additionally, data showed that the combination of NGAL, IL-18, and TIMP2 vs NGAL alone improved the AUC for AKI prediction (from 0.938 to 0.973) at 12 h.