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Vascular Adhesion Protein-1 Is Associated With Acute Kidney Injury in High-Risk Patients After Cardiac Surgery

Meersch, Melanie MD*; Küllmar, Mira MD*; Renfurm, Ronny MD; Margraf, Andreas MD*; Bormann, Eike MSc; Zarbock, Alexander MD*

doi: 10.1213/ANE.0000000000003994
Cardiovascular and Thoracic Anesthesiology: Original Clinical Research Report
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BACKGROUND: Acute kidney injury is a common complication after cardiac surgery, with a high impact on morbidity and mortality. Vascular adhesion protein-1 is involved in inflammation, which, in turn, is part of the development of acute kidney injury after cardiac surgery.

METHODS: In this ancillary study to the RENal effects of Remote Ischemic Preconditioning in cardiac surgery trial, we investigated whether vascular adhesion protein-1 might be associated with the development of acute kidney injury in high-risk patients after cardiac surgery. In total, 114 patients were included in this data set. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes criteria serum creatinine and/or urine output. Vascular adhesion protein-1 concentrations were measured at baseline (before surgery), 4 hours, and 12 hours after cardiopulmonary bypass.

RESULTS: Vascular adhesion protein-1 levels at 12 hours were significantly higher in patients with acute kidney injury (no acute kidney injury, 271 ng/mL [Q1, Q3, 179, 364 ng/mL] versus acute kidney injury, 384 ng/mL [Q1, Q3, 311, 478 ng/mL]; P < .001). Moreover, patients developing acute kidney injury had higher differences in vascular adhesion protein-1 levels between 12 hours and baseline (P < .001) and between 12 and 4 hours (P < .001) after cardiopulmonary bypass. At a cut point difference value of 99 ng/mL (95% CI, 63–133) between 12 hours and baseline, patients with differences >99 ng/mL showed a higher occurrence rate of acute kidney injury (acute kidney injury, 78.6% versus no acute kidney injury, 31.5%; P < .001). Receiver-operating characteristic curve analyses demonstrated best performance for vascular adhesion protein-1 levels at 12 hours for acute kidney injury within 72 hours after surgery, especially in the subgroup of patients with chronic kidney disease (area under the receiver-operating characteristic curve, 0.78; P < .001).

CONCLUSIONS: Vascular adhesion protein-1 is elevated in patients developing acute kidney injury assuming that vascular adhesion protein-1 plays a crucial role in the development of acute kidney injury in high-risk patients after cardiac surgery.

From the *Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany

Medical Science, Astellas Development, Leiden, the Netherlands

Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany.

Published ahead of print 8 January 2019.

Accepted for publication November 15, 2018.

Funding: This study was supported by an unrestricted research grant from Astellas.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

M. Meersch and M. Küllmar contributed equally to this work and share first authorship.

Clinical trial number: The RENal effects of Remote Ischemic Preconditioning in cardiac surgery trial is registered at http://www.drks.de (DRKS00005333).

Reprints will not be available from the authors.

Address correspondence to Alexander Zarbock, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1, 48149 Münster, Germany. Address e-mail to zarbock@uni-muenster.de.

Copyright © 2019 International Anesthesia Research Society
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