Plasma indole-3-aldehyde as a novel biomarker of acute kidney injury after cardiac surgery: a reanalysis using prospective metabolomic data
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Published:2023-11-07
Issue:1
Volume:23
Page:
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ISSN:1471-2253
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Container-title:BMC Anesthesiology
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language:en
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Short-container-title:BMC Anesthesiol
Author:
Hu Linhui,Bai Yunpeng,Lai Changchun,Mo Leitong,Li Ying,Jiang Xinyi,Xu Wang,He Yuemei,Zhou Xinjuan,Chen Chunbo
Abstract
Abstract
Background
Acute kidney injury (AKI) is a frequent complication of cardiac surgery that poses significant risks for both the development of chronic kidney diseases and mortality. Our previous study illustrated that heightened expression levels of faecal and plasma indole metabolites before the operation were associated with ischemic AKI. In this study, we aimed to validate the supposition that plasma indole-3-aldehyde (I3A) could serve as a predictive biomarker for AKI in patients undergoing cardiac surgery.
Methods
This statistical reanalysis utilized AKI metabolomic data from patients scheduled for cardiac surgery between April 2022 and July 2022 in two tertiary hospitals. Faecal and blood samples were prospectively collected before surgery within 24 h, and variables related to the preoperative, intraoperative, and postoperative periods were recorded. AKI diagnosis was based on the Kidney Disease Improving Global Outcomes criteria.
Results
In this study, 55 patients who underwent cardiac surgery were analyzed, and 27 of them (49.1%) developed postoperative AKI. Before surgery, these patients had significantly higher levels of faecal indole metabolites, including skatole, trans-3-indoleacrylic acid, and 5-methoxyindoleacetic acid. The plasma I3A, clinical model that considered perioperative and intraoperative variables, and their combination had area under the receiver operating characteristic curve (ROC) values of 0.79 (95% CI 0.67–0.91), 0.78 (95% CI 0.66–0.90), and 0.84 (95% CI 0.74–0.94) for predicting AKI, respectively. Furthermore, by utilizing net reclassification improvement and integrated discrimination improvement, plasma I3A showed significant improvements in risk reclassification compared to the clinical model alone.
Conclusions
The dysregulation of gut microbiota metabolism in patients scheduled for cardiac surgery can result in an increase in indoles from tryptophan metabolism, which may be associated with postoperative acute kidney injury (AKI). This suggests that indoles may serve as a predictive biomarker for AKI in patients undergoing cardiac surgery.
Funder
Excellent Young Talents Project of Maoming People’s Hospital Special Science and Technology Fund of Maoming City Science and Technology Planning Project of Guangdong Province of China Guangdong Basic and Applied Basic Research Foundation National Natural Science Foundation of China Outstanding Young Medical Talents in Guangdong Province Major Program of Summit Project, Guangdong Province High-level Hospital Construction Project of Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences
Publisher
Springer Science and Business Media LLC
Subject
Anesthesiology and Pain Medicine
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