Pre-operative growth differentiation factor 15 as a novel biomarker of acute kidney injury after cardiac bypass surgery

• Published in: International journal of cardiology 2015-10, Vol.197, p.66-71
• Main Authors: Guenancia, Charles, Kahli, Abdelkader, Laurent, Gabriel, Hachet, Olivier, Malapert, Ghislain, Grosjean, Sandrine, Girard, Claude, Vergely, Catherine, Bouchot, Olivier
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Aged; Biomarkers - blood; Cardiac surgery; Cardiology and cardiovascular system; Cardiopulmonary bypass; Cardiovascular; Coronary Artery Bypass - adverse effects; Female; GDF-15; Growth Differentiation Factor 15 - blood; Human health and pathology; Humans; Immunoenzyme Techniques; Life Sciences; Male; Middle Aged; Off-pump; Preoperative Period; Prospective Studies; Regression Analysis; Risk Factors; Risk stratification
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2015.06.012

Abstract Background Pre-operative GDF-15 plasma levels significantly improve the prognostic value of the EuroSCORE for mortality after cardiac surgery. However, despite the strong correlation between GDF-15 and renal function, no data are available regarding the potential interest of pre-operative GDF-15 levels to improve the prediction of acute kidney injury (AKI) after cardiac artery bypass graft (CABG) surgery. Methods All patients operated on by 2 surgeons for CABG surgery at our university hospital from September 2011 to March 2013 were screened for participation in this prospective, observational study. Exclusion criteria: age < 18 years or > 80 years, previous atrial fibrillation/flutter, previous severe renal failure, previous cardiac surgery, emergency surgery. AKI was defined according to KDIGO criteria. GDF-15 levels in plasma were measured before induction and 12 h after surgery. Results 134 patients were included in this study. 42 (31%) developed post-operative AKI. AKI patients had a significantly higher pre-operative log-GDF-15 level (OR = 3.64; 95% CI = 1.41–9.40, p = 0.008), a lower pre-operative eGFR (OR = 0.98; 95% CI = 0.96–0.99; p = 0.026), and most often underwent on-pump surgery (OR = 2.60; 95% CI = 1.14–5.96, p = 0.024). On ROC curves, GDF-15 before induction was found to be the best pre-operative biomarker to predict AKI (AUC = 0.83; CI = 0.75–0.89), compared with eGFR (AUC = 0.67; 95% CI = 0.59–0.75), p = 0.003 and NT-proBNP (AUC = 0.62; CI = 0.51–0.72), p < 0.001. Pre-operative GDF-15 was also significantly better than the EuroSCORE in predicting AKI (AUC 0.62, 95% CI = 0.54–0.70), p < 0.001. Conclusions Pre-operative GDF-15 plasma levels are associated with post-operative AKI in CABG patients. If confirmed in larger cohorts, pre-operative GDF-15 may be of value to improve pre-operative risk stratification among candidates for surgery.