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dc.contributor.authorEnger, Tone Bull
dc.contributor.authorPleym, Hilde
dc.contributor.authorStenseth, Roar
dc.contributor.authorGreiff, Guri
dc.contributor.authorWahba, Alexander
dc.contributor.authorVidem, Vibeke
dc.date.accessioned2017-10-26T09:16:45Z
dc.date.available2017-10-26T09:16:45Z
dc.date.created2017-01-04T08:34:16Z
dc.date.issued2016
dc.identifier.issn1053-0770
dc.identifier.urihttp://hdl.handle.net/11250/2462304
dc.description.abstractObjective To investigate whether a multimarker strategy combining preoperative biomarkers representing distinct pathophysiologic pathways enhances preoperative risk assessment of acute kidney injury after cardiac surgery (CSA-AKI) and increases knowledge of underlying pathogenesis. Design Prospective, cohort study. Setting Single-center tertiary referral hospital. Participants The study comprised 1,015 adults undergoing cardiac surgery with cardiopulmonary bypass. Interventions CSA-AKI was defined as≥50% increase in serum creatinine concentration, absolute increase≥26 µmol/L, or new requirement for dialysis. Preoperative and perioperative information until hospital discharge was recorded. Preoperative plasma levels of C-reactive protein, terminal complement complex, neopterin, lactoferrin, N-terminal pro-brain natriuretic peptide, and cystatin C were determined using enzyme immunoassays. Biomarkers were selected based on causal hypotheses of underlying mechanisms and were related to inflammatory, hemodynamic, or renal signaling pathways. Measurements and Main Results One hundred patients (9.9%) developed CSA-AKI. Higher baseline plasma concentrations of neopterin and N-terminal pro-brain natriuretic peptide were associated independently with CSA-AKI (p = 0.04 and p<0.001, respectively). Lower baseline plasma lactoferrin concentrations were observed in patients with CSA-AKI (p = 0.05). Compared with clinical risk assessment, addition of these biomarkers provided a slight, but significant, increment in predictive utility (area under the curve 0.81-0.83, likelihood ratio test p<0.001). A net of 12% of patients were reclassified correctly, and improved prediction was demonstrated, especially in patients with intermediate risk (56% correct reclassification). Conclusions Preoperative hemodynamic, renal, and immunologic function play central roles in the pathogenesis of CSA-AKI. These findings add evidence to the potential of a multimarker approach to improve preoperative prediction of CSA-AKI.nb_NO
dc.language.isoengnb_NO
dc.publisherWB Saundersnb_NO
dc.titleA Preoperative Multimarker Approach to Evaluate Acute Kidney Injury After Cardiac Surgery.nb_NO
dc.typeJournal articlenb_NO
dc.typePeer reviewednb_NO
dc.description.versionacceptedVersionnb_NO
dc.source.journalJournal of Cardiothoracic and Vascular Anesthesianb_NO
dc.identifier.doi10.1053/j.jvca.2016.10.005
dc.identifier.cristin1420413
dc.description.localcode© 2016 WB Saunders. This is the authors’ accepted and refereed manuscript to the article.nb_NO
cristin.unitcode194,65,10,0
cristin.unitcode194,65,25,0
cristin.unitnameInstitutt for laboratoriemedisin, barne- og kvinnesykdommer
cristin.unitnameInstitutt for sirkulasjon og bildediagnostikk
cristin.ispublishedtrue
cristin.fulltextpostprint
cristin.qualitycode1


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