Perioperative serum syndecan-1 concentrations in patients who underwent cardiovascular surgery with cardiopulmonary bypass and its association with the occurrence of postoperative acute kidney injury: A retrospective observational study

Author:

Miyazaki Atsushi1,Hokka Mai1,Obata Norihiko1,Mizobuchi Satoshi1

Affiliation:

1. Kobe University Graduate School of Medicine

Abstract

Abstract

Background Various factors can cause vascular endothelial damage during cardiovascular surgery (CVS) with cardiopulmonary bypass (CPB), which has been suggested to be associated with postoperative complications. However, few studies have specifically investigated the relationship between the degree of vascular endothelial damage and postoperative acute kidney injury (pAKI). The objectives of this study were to measure perioperative serum syndecan-1 concentrations in patients who underwent CVS with CPB, evaluate their trends, and determine their association with pAKI. Methods This was a descriptive and case‒control study conducted at the National University Hospital. Adult patients who underwent CVS with CPB at a national university hospital between March 15, 2016, and August 31, 2020, were included. Patients who were undergoing preoperative dialysis, had preoperative serum creatinine concentrations greater than 2.0 mg dl-1, who were undergoing surgery involving the descending aorta were excluded. The perioperative serum syndecan-1 concentration was measured, and its association with pAKI was investigated. Results Fifty-two patients were included. pAKI occurred in 18 (34.6%) of those patients. The serum syndecan-1 concentration increased after CPB initiation and exhibited bimodal peak values. The serum syndecan-1 concentration at all time points was significantly elevated compared to that after the induction of anesthesia. The serum syndecan-1 concentration at 30 min after weaning from CPB and on postoperative day 1 was associated with the occurrence of pAKI (OR=1.10 [1.01 to 1.21], P=0.03]; OR=1.16 [1.01 to 1.34], P=0.04]; and the cutoff values of the serum syndecan-1 concentration that resulted in pAKI were 101.0 ng ml-1 (sensitivity=0.71, specificity=0.62, area under the curve (AUC)=0.67 (0.51 to 0.83)) and 57.1 ng ml-1 (sensitivity=0.82, specificity=0.56, AUC=0.71 (0.57 to 0.86)). Multivariate logistic regression analysis revealed that the serum syndecan-1 concentration on postoperative day 1 was associated with the occurrence of pAKI (OR=1.02 [1.00 to 1.03]; P=0.03). Conclusion The serum syndecan-1 concentration at all time points was significantly greater than that after the induction of anesthesia. The serum syndecan-1 concentration on postoperative day 1 was significantly associated with the occurrence of pAKI. Trial registration This study is not a clinical trial and is not registered with the registry.

Publisher

Research Square Platform LLC

Reference17 articles.

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3. Vascular endothelial cell changes in postcardiac surgery acute kidney injury;Qureshi SH;Am J Physiol Ren Physiol,2018

4. Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery;Castelo Branco KM;J Thorac Cardiovasc Surg,2016

5. High Preoperative Serum Syndecan-1, a Marker of Endothelial Glycocalyx Degradation, and Severe Acute Kidney Injury after Valvular Heart Surgery;Kim HB;J Clin Med,2020

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