Ischemia modified albumin and acute kidney injury in pump-on cardiac surgery

Introduction and Aims: Neutrophil gelatinase-associated lipocalin (NGAL) is one of the biomarkers of acute kidney injury (AKI). Ischemia Modified Albumin (IMA) is a new marker used to detect acute ischemic events. The aim of our study was to determine the role of IMA in the development of AKI and/or is IMA a marker of AKI in patients undergoing pump-on cardiac surgery. Methods: This is a prospective study of patients who were underwent pump-on cardiac surgery due to coronary artery bypass grafting and/or cardiac valve surgery. AKI defined according to KDIGO AKI guideline. Blood samples for measurement of IMA, NGAL and creatinin levels were collected prior to cardiac surgery (0h) and in the time course on 2nd, 12th and 24th hours after conducted surgery (2h 12h and 24h respectively), and neutrophil-to-lymphocyte ratio (NLR) was calculated from hemogram as well. Patients with developed AKI were divided in to two subgroups that had non progressed and progressed AKI. Criteria for progression of AKI included: the transition from the I stage to the II or III, from the II stage to the III stage and the beginning of CRRT. Results: Fourty eight patients (31 male, 17 female) were included to the study. After cardiac surgery 33 patients developed any stage of AKI, 22 of them non-progressed AKI, 11 - progressed AKI. The basal characteristics of patients showed in table. All of the markers significantly increased after cardiac surgery, but IMA and NLR levels not differed between groups. ROC analysis of 2nd hours markers showed that NGAL and creatinin had significantly large area under the curve (AUC) than IMA and NLR to predict AKI developed at 24 hours. Conclusions: IMA as well as NLR increased after cardiac surgery, but not predicted development of AKI. (Table presented).