Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 3, May-June, p. 377–386

Publication type: original article

Language: English

Serum Interleukin 6 Levels as an Early Marker of Acute Kidney Injury in Children After Cardiac Surgery

Znaczenie interleukiny 6 w surowicy jako wczesnego markera ostrego uszkodzenia nerek u dzieci po operacjach kardiochirurgicznych

Monika Miklaszewska1,A,B,D,F, Przemysław Korohoda2,C,D,F, Katarzyna Zachwieja1,A, Tomasz Mroczek3,B, Dorota Drożdż1,E, Krystyna Sztefko4,B, Anna Moczulska1,B, Jacek A. Pietrzyk1,E,F

1 Department of Pediatric Nephrology, Jagiellonian University Medical college, cracow, Poland

2 University of Science and Technology (aGH), faculty of computer Science, electronics and Telecommunications; chair of electronics, cracow, Poland

3 Department of Pediatric Cardiac Surgery, Jagiellonian University Medical college, cracow, Poland

4 Department of Clinical Biochemistry, University children’s Hospital of cracow, Poland

Abstract

Background. Cardiosurgical operations in cardiopulmonary bypass (cPb) constitute a risk of acute kidney injury (aKI).
Objectives. The aim of the study was an assessment of aKI risk in children within the first 24 hours after cPb cardiac surgery, evaluating serum interleukin 6 (sIL6).
Material and Methods. The study included 47 children with congenital heart disease operated in cPb. blood samples were taken before the procedure (0 hour) as well as at 2, 6, 12, 18 and 24 hours after the operation.
Results. aKI was confirmed in 19 children. The mean sIL6 concentration in the aKI compared with non-aKI group was: 180.6 vs. 93.7; p = 0.0017. The maximum sIL6 in the aKI group was obtained at 2 hrs after cPb (350.36 pg/ml). Logistic regression analysis for aKI development depending on the value of sIL6 at 2 hrs after cPb proved that every rise of sIL6 by 100 pg/ml increased the chance of aKI development by 70% (p = 0.0161). With every circulatory arrest time prolongation by 10 minutes for a given sIL6 concentration, the chance of aKI development increased by 47% (p = 0.0407). aKI risk at 2 hrs after cPb, for a sIL6 cut-off point amounting to 185 pg/ml, increased more than 3-fold (aUROc – 68%).
Conclusion. . determining sIL6 in children after cardiosurgical operations at 2 hrs after the procedure constitutes a good, yet not a perfect marker of aKI risk development. Nomograms of the constant risk values of aKI were worked out presenting the ranges of values in relation to serum IL6 concentrations and the child’s body mass, age and the time of circulatory arrest.

Streszczenie

Wprowadzenie. Zabiegi kardiochirurgiczne w krążeniu pozaustrojowym (cardiopulmonary bypass
Cel pracy. Ocena ryzyka aKI u dzieci w okresie pierwszych 24 godzin po zabiegu cPb z wykorzystaniem oceny stężenia IL6 w surowicy (sIL6).
Materiał i metody. do badania włączono 47 dzieci z wrodzoną wadą serca, operowanych w cPb. Próbki krwi pobierano przed zabiegiem (godz. 0) oraz w 2., 6., 12., 18., 24. godzinie po zabiegu.
Wyniki. aKI stwierdzono u 19 dzieci. Średnie stężenie sIL6 w grupie z aKI w porównaniu do grupy bez aKI wynosiło: 180,6 vs aKI0: 93,7; p = 0,0017. Wartość maksymalna stężenia sIL6 dla aKI1 została osiągnięta w 2. godzinie po cPb (350,36 pg/ml). analiza regresji logistycznej dla wystąpienia aKI w zależności od wartości sIL6 w 2. godzinie po cPb wykazała, że każdy wzrost sIL6 o 100 pg/ml. zwiększył szansę na wystąpienie aKI o 70% (p = 0,0161). Każde wydłużenie czasu zatrzymania akcji serca o 10 minut dla danego stężenia sIL6 zwiększało szansę na wystąpienie aKI o 47% (0.0407). Ryzyko wystąpienia aKI w 2. godzinie po cPb dla punktu odcięcia sIL6 wynoszącego 185 pg/ml wzrastało ponad 3-krotnie (aUROc – 68%).
Wnioski. Oznaczanie sIL6 u dzieci po zabiegach kardiochirurgicznych w 2. godzinie po operacji jest dobrym, ale nie doskonałym markerem ryzyka wystąpienia aKI. Wyniki pracy pozwoliły na opracowanie diagramów przedstawiających przedziały określonej wartości stałej szansy oraz stałego ryzyka wystąpienia aKI w zależności od wartości stężenia sIL6 oraz masy ciała dziecka, wieku oraz czasu zatrzymania krążenia.

Key words

acute kidney injury, serum IL6, cardiopulmonary bypass, children.

Słowa kluczowe

ostre uszkodzenie nerek, IL6 w surowicy, krążenie pozaustrojowe, dzieci.

References (30)

  1. Mc Ilroy DR, Wagener G, Lee T: biomarkers of acute Kidney Injury. an evolving domain. anesthesiology 2010, 112, 998–1004.
  2. Ramesh G, Krawczeski CD, Woo JG, et al.: Urinary Netrin-1 Is an early Predictive biomarker of acute Kidney Injury after cardiac Surgery. clin J am Soc Nephrol 2010, 5, 395–401.
  3. Devarajan P: biomarkers for the early detection of acute kidney injury. curr Opin Ped 2011, 23, 194–200.
  4. Sorof JM, Stromberg D, Brewer ED, et al.: early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol 1999, 13, 641–645.
  5. Mishra J, Dent C, Tarabishi R, et al.: Neutrophil gelatinase-associated lipocalin (NGaL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005, 365, 1231–1238.
  6. Haase M, Bellomo R, Devarajan P, et al.: accuracy of Neutrophil Gelatinase-associated Lipocalin (NGaL) in diagnosis and Prognosis in acute Kidney Injury: a Systematic Review and Meta-analysis. am J Kidney dis 2009, 54, 1012–1024.
  7. Nguyen MT, Devarajan P: biomarkers for the early detection of acute kidney injury. Pediatr Nephrol 2007, 23, 2151–2157.
  8. Bellomo R, Kellum JA, Ronco C: defining acute renal failure: physiological principles. Int care Med 2004, 30, 33–37.
  9. Devarajan P: The future of pediatric aKI management biomarkers. Semin Nephrol 2008, 28, 493–498.
  10. Askenazi DJ, Ambalavanan N, Goldstein SL: acute kidney injury in critically ill newborns: What do we know? What do we need to learn? Pediatr Nephrol 2009, 24, 265–274.
  11. Goldstein SL, Somers MJ, Baum MA, et al.: Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005, 67, 653.
  12. Mak R: acute kidney injury in children: the dawn of a new era. Pediatr Nephrol 2008, 23, 2147–2149.
  13. Schwartz G, Munoz A, Schneider M, et al.: New equations to estimate GfR in children with cKd. J am Soc Nephrol 2009, 20, 629.
  14. Kwon O, Molitoris BA, Pescovitz M, et al.: Urinary actin, interleukin-6, and interleukin-8 may predict sustained aRf after ischemic injury in renal allografts. am J Kid dis 2003, 41,1074.
  15. Dennen P, Altmann C, Kaufman J, et al.: Urine interleukin-6 is an early biomarker of acute kidney injury in children undergoing cardiac surgery. crit care 2010, 14, R1 81.
  16. Dittrich S, Kurschat K, Dähnert I, et al.: Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J cardiol 2000, 28, 73, 2, 173–179.
  17. Dittrich S, Priesemann M, Fischer T, et al.: circulatory arrest and renal function in open-heart surgery on infants. Pediatr cardiol 2002, 23, 1, 15–19.
  18. Loef BG, Epema AH, Smilde TB, et al.: Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J am Soc Nephrol 2005, 16, 195–200.
  19. Tuttle KR, Worrall NK, Dahlstrom LR, et al.: Predictors of aRf after cardiac surgical procedures. am J Kidney dis 2003, 41, 76–83.
  20. Liu KD, Altmann C, Smits G, et al.: Serum Interleukin-6 and interleukin-8 are early biomarkers of acute kidney injury and predict prolonged mechanical ventilation in children undergoing cardiac surgery: a case-control study. crit care 2009, 13, R1 04.
  21. Parikh C, Mishra J, Thiessen-Philbrook H, et al.: Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery. Kidney Int 2006, 70, 199–203.
  22. Bennett M, Dent C, Ma Q, et al.: Urine NGaL Predicts Severity of acute Kidney Injury after cardiac Surgery: a Prospective Study. clin J am Soc Nephrol 2008, 3, 665–673.
  23. Dent C, Ma Q, Dastrala S, et al.: Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. crit care 2007, 11, R1 27.
  24. Krawczeski CD, Vandevoorde R, Kathman T, et al.: Serum cystatin c Is an early Predictive biomarker of acute Kidney Injury after Pediatric cardiopulmonary bypass. clin J am Soc Nephrol 2010, 9, 1552–1557.
  25. Krawczeski CD, Woo JG, Wang Y, et al.: Neutrophil Gelatinase-associated Lipocalin concentrations Predict development of acute Kidney Injury in Neonates and children after cardiopulmonary bypass. J Ped 2011, 158, 1009–1015.
  26. Hoke TS, Douglas IS, Klein CL, et al.: acute renal failure after bilateral nephrectomy is associated with cytokine mediated pulmonary injury. J am Soc Nephrol 2007, 18, 155–164.
  27. Kumar AB, Suneja M: cardiopulmonary bypass-associated acute Kidney Injury. anesthesiology 2011, 114, 964–970.
  28. Simmons EM, Himmelfarb J, Sezer MT, et al.: Plasma cytokine levels predict mortality in patients with acute renal failure. Kidney Int 2004, 65, 1357–1365.
  29. Xin C, Yulong X, Yu C, et al.: Urine Neutrophil Gelatinase-associated Lipocalin and Interleukin-18 Predict acute Kidney Injury after cardiac Surgery. Renal failure 2008, 30, 904–913.
  30. Panichi V, Migliori M, DePietro S, et al.: The link of biocompatibility to cytokine production. Kidney Int 2000 (Suppl. 76), 58, S96.
© Wroclaw Medical University