Assessing the predictive value of elevated postoperative syndecan-1 levels for progressive acute kidney injury and kidney replacement therapy necessity in adult cardiac surgery patients

• Published in: BMC cardiovascular disorders Vol. 24; no. 1; pp. 1 - 11
• Main Authors: Jiang, Wuhua, Su, Ying, Su, Yiqi, Xu, Jiarui, Fang, Yi, Teng, Jie, Ding, Xiaoqiang, Luo, Zhe, Xu, Xialian
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 09.08.2024; BioMed Central; BMC
• Subjects: Acute kidney injury; Acute renal failure; Analysis; Biological markers; Biomarkers; Bypass; Cardiac surgery; Care and treatment; Complications and side effects; Coronary artery; Coronary artery bypass; Coronary vessels; Creatinine; Cytokines; Development and progression; Endothelial injury; Health aspects; Heart; Heart surgery; Hospitals; Kidney diseases; Kidney replacement therapy; Kidneys; Morbidity; Mortality; Patients; Population studies; Renal replacement therapy; Risk factors; Syndecan; Syndecan-1; China
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-04061-0

Background The development of acute kidney injury (AKI) post-cardiac surgery significantly increases patient morbidity and healthcare costs. Prior researches have established Syndecan-1 (SDC-1) as a potential biomarker for endothelial injury and subsequent acute kidney injury development. This study assessed whether postoperative SDC-1 levels could further predict AKI requiring kidney replacement therapy (AKI-KRT) and AKI progression. Methods In this prospective study, 122 adult cardiac surgery patients, who underwent valve or coronary artery bypass grafting (CABG) or a combination thereof and developed AKI within 48 h post-operation from May to September 2021, were monitored for the progression to stage 2-3 AKI or the need for KRT. We analyzed the predictive value of postoperative serum SDC-1 levels in relation to multiple endpoints. Results In the study population, 110 patients (90.2%) underwent cardiopulmonary bypass, of which thirty received CABG or combined surgery. Fifteen patients (12.3%) required KRT, and thirty-eight (31.1%) developed progressive AKI, underscoring the severe AKI incidence. Multivariate logistic regression indicated that elevated SDC-1 levels were independent risk factors for progressive AKI (OR = 1.006) and AKI-KRT (OR = 1.011). The AUROC for SDC-1 levels in predicting AKI-KRT and AKI progression was 0.892 and 0.73, respectively, outperforming the inflammatory cytokines. Linear regression revealed a positive correlation between SDC-1 levels and both hospital ([beta] = 0.014, p = 0.022) and ICU stays ([beta] = 0.013, p < 0.001). Conclusion Elevated postoperative SDC-1 levels significantly predict AKI progression and AKI-KRT in patients following cardiac surgery. The study's findings support incorporating SDC-1 level monitoring into post-surgical care to improve early detection and intervention for severe AKI. Keywords: Cardiac surgery, Acute kidney injury, Risk factors, Syndecan-1, Endothelial injury, Kidney replacement therapy