Early prediction of acute kidney injury with cell cycle arrest biomarkers using plethesmography directed fluid management in major abdominal surgery

Abstract

Background Acute kidney injury (AKI) is a known complication after major abdominal surgery. Use of the usual functional AKI biomarkers for detection shows delayed results, and so, the use of cell cycle arrest biomarker was proposed.Purpose The aim of the present study was to assess the arrest biomarker as an early tool for AKI prediction in major abdominal surgery.Methods After receiving approval from the Ethics Committee and taking informed written consent, a prospective randomized study was conducted. Forty adult patients were scheduled for major abdominal surgery. Patients were randomly categorized using closed-envelope technique into two equal groups (25 patients each): the control group (20 patients) with intraoperative standard fluid therapy and the goal-directed fluid therapy (GDT) (20 patients) using plethysmography. Urinary cycle arrest biomarkers were measured at 4 and 12 h after ICU admission.Results The mean value of the arrest biomarkers showed a significant increase in the control group only at 4 h period (p = 0.017). Moreover, there was a statistically significant increase in the number of positive patients in the control group at 4 h period only (p = 0.044). Urine arrest biomarkers were higher in AKI patients than in the non-AKI ones at 4 h (p = 0.003) and 12 h (p = 0.004). The arrest biomarker AUROC values at 4 and 12 h were 0.887 and 0.875, respectively.Conclusion From these results, we concluded that cell cycle arrest biomarkers can predict AKI after major abdominal surgery. In addition, AKI incidence showed no difference between the control group and the GDT group.

Keywords

• Prediction
• cell cycle arrest biomarkers
• acute kidney injury
• major abdominal surgery
• plethysmography