Abstract:
Objective To explore the value of inflammation cytokines for predicting the postoperative occurrence of acute kidney injury(AKI)after surgery for congenital heart disease in children.
Methods From February 2018 to November 2020,139 cases of congenital heart disease undergoing cardiopulmonary bypass surgery were recruited and divided into two groups of AKI and non-AKI. Children in AKI group were further divided into AKI with progression and AKI without progression according to whether or not renal function worsened persistently. The groups were compared with regards to the levels of interleukin(IL)-2,IL-4,IL-6,IL-8,IL-10,tumor necrosis factor-α(TNF-α),interferon-γ (IFN-γ)in sera and liver fatty acid binding protein(L-FABP),neutrophil gelatinase-associated lipocalin (NGAL)in urine. Correlation analysis was performed between those factors and AKI and AKI occurring predicated by area under the ROC curve (AUC).
Results Cardiopulmonary bypass (CBP) time(133. 6±31. 5)min
vs(102. 8±19. 8)min,142. 6(52. 5,288. 6)min
vs 115. 7(64. 8,69. 4)min, aortic cross-clamp time(68. 5±29. 7)min
vs(52. 0±36. 5)min,73(56. 5,93. 8)min
vs 56(40. 5, 72. 2)min,PICU stay9. 7(6. 4,17. 2)d
vs 4. 2(2. 2,7. 2)d,11. 5(10. 6,15. 5)d
vs 5. 3(4. 3,9. 7) d,hospital stay15. 7(11. 3,19. 2)d
vs 9. 5(8. 5,13. 5)d,21. 7(15. 8,32. 6)d
vs 10. 2(9. 4,17. 6) d,mechanical ventilation time5. 7(1. 4,12. 2)d
vs 2. 8(2. 0,8. 9)d,7. 7(5. 2,18. 7)d
vs 4. 8(2. 2, 12. 2)dof AKI and AKI with progression groupa were longer than those of non-AKI and AKI without progression groups(
P<0. 05). The levels of IL-22. 4(1. 1,2. 7)ng/L
vs 0. 9(0. 5,2. 3)ng/L,2. 9 (1. 1,3. 6)ng/L
vs 1. 3(1. 1,1. 9)ng/L,IL-641. 3(6. 1,86. 5)ng/L
vs 3. 1(1. 2,3. 9)ng/L,56. 4 (7. 7,108. 6)ng/L
vs 38. 5(6. 3,74. 2)ng/L,IL-852. 9(16. 8,100. 2)ng/L
vs 2. 9(1. 9,4. 3)ng/L, 84. 5(43. 3,168. 7)ng/L
vs 45. 2(9. 6,84. 3)ng/L,IL-1046. 8(7. 1,136. 4)ng/L
vs 1. 3(0. 8,7. 7) ng/L,66. 7(7. 9,244. 8)ng/L
vs 38. 2(6. 8,106. 7)ng/Lin sera and L-FABP63. 2(4. 2,167. 3) ng/L
vs 4. 5(2. 4,6. 5)ng/L,94. 6(3. 9,268. 7)ng/L
vs 25. 8(5. 6,103. 2)ng/L,NGAL18. 3 (10. 9,46. 3)ng/L
vs 3. 6(1. 8,5. 2)ng/L,29. 3(16. 7,85. 4)ng/L
vs 9. 6(1. 1,25. 6)ng/Lin urine at Day 1 post-operation were higher in AKI and AKI with progression groups than those in non-AKI and AKI without progression groups(
P<0. 05). ROC analysis revealed that IL-6,IL-8,L-FABP and NGAL could predict the occurrence of AKI with AUC 0. 79,0. 81,0. 75 and 0. 74(
P<0. 05)respectively. Furthermore,serum IL-8 and urinary L-FABP could predict the progression of AKI with AUC 0. 82 and 0. 81(
P<0. 05).
Conclusion IL-6,IL-8,L-FABP and NGAL are obviously elevated in AKI so that they have prediction values of AKI. And marked elevations of IL-8 and L-FABP in children with AKI progression offer prediction values for AKI progression.