Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UFC |
Texto Completo: | http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=17748 |
Resumo: | Background: Acute kidney injury (AKI) is common after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage and its early increment after surgery can be associated with AKI. Objectives: evaluate Syndecan-1 and others biomarkers as predictors of severe AKI after pediatric cardiac surgery. Methods: Prospective cohort study with 289 patients less than 18 years old submitted to cardiac surgery at one reference institution. Postoperative plasma syndecan-1, intercellular adhesion molecule -1 (ICAM-1), e-selectine and neutrophil gelatinase-associated lipocalin (NGAL) were measured within the first 2 hours after cardiac surgery. Severe AKI âdefined according Kidney Disease Improvement Global Outcome (KDIGO) stage 2 or 3- doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization- was the main outcome. Analyses were adjusted for clinical variables for AKI risk stratification, including age, sex, preoperative estimated glomerular filtration rate, type of surgery, use of and cardiopulmonary bypass time longer than 120 minutes and ârenal angina indexâ components - early decrease in estimated creatinine clearance from baseline and increase in % ICU fluid overload in the first day postoperative. Results: Plasma syndecan-1 measured early postoperative was independently associated with severe AKI. The accuracy of postoperative syndecan-1 for diagnosis of severe AKI was moderate (AUC-ROC of 0.77, 95% CI 0.68 â 0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (p=0.004) and it also improved risk prediction as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Postoperative sundecan-1 was also independently associated with longer length of ICU and hospital stay. N-GAL, e-selectine and I-CAM -1 were not associated with AKI and other outcomes. Conclusions: Postoperative plasma syndecan-1 is associated with subsequent severe AKI and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for AKI after cardiac surgery. |
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Biblioteca Digital de Teses e Dissertações da UFC |
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info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisSyndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtricaSyndecan-1: severe acute kidney injury predictor after pediatric cardiac surgery2016-06-06Alexandre Braga LibÃrio64738450387http://lattes.cnpq.br/1953734600948522Arnaldo Aires Peixoto JÃnior70903271320http://buscatextual.cnpq.br/buscatextual/visualizacv.jsp?id=K4760217H0Elizabeth de Francesco Daher18772919353http://lattes.cnpq.br/4855968398515646Felipe Augusto Matos Silva00050000088KlÃbia MagalhÃes Pereira Castello Branco46548424387http://lattes.cnpq.br/103023479070235877115023387Candice Torres de Melo BezerraUniversidade Federal do CearÃPrograma de PÃs-GraduaÃÃo em CiÃncias MÃdicasUFCBRMEDICINABackground: Acute kidney injury (AKI) is common after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage and its early increment after surgery can be associated with AKI. Objectives: evaluate Syndecan-1 and others biomarkers as predictors of severe AKI after pediatric cardiac surgery. Methods: Prospective cohort study with 289 patients less than 18 years old submitted to cardiac surgery at one reference institution. Postoperative plasma syndecan-1, intercellular adhesion molecule -1 (ICAM-1), e-selectine and neutrophil gelatinase-associated lipocalin (NGAL) were measured within the first 2 hours after cardiac surgery. Severe AKI âdefined according Kidney Disease Improvement Global Outcome (KDIGO) stage 2 or 3- doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization- was the main outcome. Analyses were adjusted for clinical variables for AKI risk stratification, including age, sex, preoperative estimated glomerular filtration rate, type of surgery, use of and cardiopulmonary bypass time longer than 120 minutes and ârenal angina indexâ components - early decrease in estimated creatinine clearance from baseline and increase in % ICU fluid overload in the first day postoperative. Results: Plasma syndecan-1 measured early postoperative was independently associated with severe AKI. The accuracy of postoperative syndecan-1 for diagnosis of severe AKI was moderate (AUC-ROC of 0.77, 95% CI 0.68 â 0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (p=0.004) and it also improved risk prediction as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Postoperative sundecan-1 was also independently associated with longer length of ICU and hospital stay. N-GAL, e-selectine and I-CAM -1 were not associated with AKI and other outcomes. Conclusions: Postoperative plasma syndecan-1 is associated with subsequent severe AKI and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for AKI after cardiac surgery. IntroduÃÃo: A lesÃo renal aguda (LRA) à uma complicaÃÃo comum apÃs cirurgia cardÃaca pediÃtrica e està associada com resultados desfavorÃveis. Syndecan-1 à um biomarcador do dano ao glicocÃlix endotelial e seu aumento precoce apÃs cirurgia pode estar associado à LRA. Objetivos: avaliar o Syndecan-1 e outros biomarcadores como preditores precoces de LRA grave apÃs cirurgia cardÃaca. Metodologia: Estudo de coorte prospectivo com 289 pacientes menores de 18 anos submetidos à cirurgia cardÃaca em uma instituiÃÃo de referÃncia. Nas primeiras duas horas de cirurgia, foram realizadas as dosagens dos biomarcadores: Syndecan-1, Intercellular adhesion molecule-1 (ICAM-1), e-Selectina e Neutrophil gelatinase-associated lipocalin (NGAL). O diagnÃstico de LRA grave foi definido de acordo com a classsificaÃÃo da Kidney Disease Improving Global Outcome (KDIGO) estÃgio 2 ou 3 (duplicaÃÃo dos valores de creatinina sÃrica em relaÃÃo aos valores prÃ-operatÃrios ou necessidade de diÃlise durante internamento). As anÃlises foram ajustadas de acordo um modelo clÃnico de estratificaÃÃo de risco para LRA, com inclusÃo das seguintes variÃveis: idade, sexo, pressÃo arterial sistÃlica na admissÃo na unidade de terapia intensiva (UTI), taxa de filtraÃÃo glomerular prÃ-operatÃria, tipo de cirurgia, uso e tempo de circulaÃÃo extracorpÃrea maior que 120 minutos e componentes do Ãndice de Angina Renal (diminuiÃÃo precoce do clearance de creatinina estimado em relaÃÃo à linha de base e aumento, em porcentagem, do acÃmulo de lÃquido no primeiro dia de pÃs-operatÃrio - PO). Resultados: Syndecan-1 plasmÃtico dosado nas primeiras 2 horas de PO foi independentemente associado com LRA grave. A acurÃcia do Syndecan-1 PO para diagnÃstico de LRA grave foi moderada (Ãrea sob curva ROC de 0,77, IC 95% 0,68 â 0,85). A adiÃÃo do Syndecan-1 melhorou a capacidade discriminatÃria do modelo clÃnico de 0,80 para 0,86 (p=0,004) e tambÃm aumentou a prediÃÃo de risco para LRA, utilizando o Net reclassification improvement (NRI) e o Integrated discrimination improvement (NDI). O Syndecan-1 PO apresentou associaÃÃo direta com os tempos de permanÃncia em unidade de terapia intensiva (UTI) e hospitalar. Os outros marcadores de ativaÃÃo endotelial e o NGAL nÃo apresentam associaÃÃo LRA e nem com outros desfechos clÃnicos. ConclusÃo: Syndecan-1 plasmÃtico està associado com LRA grave subseqÃente e piores desfechos clÃnicos em crianÃas submetidas a cirurgias cÃrdicas. Pode ser um biomarcador precoce Ãtil para identificaÃÃo de pacientes com risco elevado de LRA apÃs cirurgias cardÃacas. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=17748application/pdfinfo:eu-repo/semantics/openAccessporreponame:Biblioteca Digital de Teses e Dissertações da UFCinstname:Universidade Federal do Cearáinstacron:UFC2019-01-21T11:30:57Zmail@mail.com - |
dc.title.pt.fl_str_mv |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
dc.title.alternative..fl_str_mv |
Syndecan-1: severe acute kidney injury predictor after pediatric cardiac surgery |
title |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
spellingShingle |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica Candice Torres de Melo Bezerra MEDICINA |
title_short |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
title_full |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
title_fullStr |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
title_full_unstemmed |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
title_sort |
Syndecan-1: preditor de lesÃo renal aguda grave apÃs cirurgia cardÃaca pediÃtrica |
author |
Candice Torres de Melo Bezerra |
author_facet |
Candice Torres de Melo Bezerra |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Alexandre Braga LibÃrio |
dc.contributor.advisor1ID.fl_str_mv |
64738450387 |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/1953734600948522 |
dc.contributor.referee1.fl_str_mv |
Arnaldo Aires Peixoto JÃnior |
dc.contributor.referee1ID.fl_str_mv |
70903271320 |
dc.contributor.referee1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.jsp?id=K4760217H0 |
dc.contributor.referee2.fl_str_mv |
Elizabeth de Francesco Daher |
dc.contributor.referee2ID.fl_str_mv |
18772919353 |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/4855968398515646 |
dc.contributor.referee3.fl_str_mv |
Felipe Augusto Matos Silva |
dc.contributor.referee3ID.fl_str_mv |
00050000088 |
dc.contributor.referee4.fl_str_mv |
KlÃbia MagalhÃes Pereira Castello Branco |
dc.contributor.referee4ID.fl_str_mv |
46548424387 |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/1030234790702358 |
dc.contributor.authorID.fl_str_mv |
77115023387 |
dc.contributor.author.fl_str_mv |
Candice Torres de Melo Bezerra |
contributor_str_mv |
Alexandre Braga LibÃrio Arnaldo Aires Peixoto JÃnior Elizabeth de Francesco Daher Felipe Augusto Matos Silva KlÃbia MagalhÃes Pereira Castello Branco |
dc.subject.cnpq.fl_str_mv |
MEDICINA |
topic |
MEDICINA |
dc.description.abstract.por.fl_txt_mv |
Background: Acute kidney injury (AKI) is common after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage and its early increment after surgery can be associated with AKI. Objectives: evaluate Syndecan-1 and others biomarkers as predictors of severe AKI after pediatric cardiac surgery. Methods: Prospective cohort study with 289 patients less than 18 years old submitted to cardiac surgery at one reference institution. Postoperative plasma syndecan-1, intercellular adhesion molecule -1 (ICAM-1), e-selectine and neutrophil gelatinase-associated lipocalin (NGAL) were measured within the first 2 hours after cardiac surgery. Severe AKI âdefined according Kidney Disease Improvement Global Outcome (KDIGO) stage 2 or 3- doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization- was the main outcome. Analyses were adjusted for clinical variables for AKI risk stratification, including age, sex, preoperative estimated glomerular filtration rate, type of surgery, use of and cardiopulmonary bypass time longer than 120 minutes and ârenal angina indexâ components - early decrease in estimated creatinine clearance from baseline and increase in % ICU fluid overload in the first day postoperative. Results: Plasma syndecan-1 measured early postoperative was independently associated with severe AKI. The accuracy of postoperative syndecan-1 for diagnosis of severe AKI was moderate (AUC-ROC of 0.77, 95% CI 0.68 â 0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (p=0.004) and it also improved risk prediction as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Postoperative sundecan-1 was also independently associated with longer length of ICU and hospital stay. N-GAL, e-selectine and I-CAM -1 were not associated with AKI and other outcomes. Conclusions: Postoperative plasma syndecan-1 is associated with subsequent severe AKI and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for AKI after cardiac surgery. IntroduÃÃo: A lesÃo renal aguda (LRA) à uma complicaÃÃo comum apÃs cirurgia cardÃaca pediÃtrica e està associada com resultados desfavorÃveis. Syndecan-1 à um biomarcador do dano ao glicocÃlix endotelial e seu aumento precoce apÃs cirurgia pode estar associado à LRA. Objetivos: avaliar o Syndecan-1 e outros biomarcadores como preditores precoces de LRA grave apÃs cirurgia cardÃaca. Metodologia: Estudo de coorte prospectivo com 289 pacientes menores de 18 anos submetidos à cirurgia cardÃaca em uma instituiÃÃo de referÃncia. Nas primeiras duas horas de cirurgia, foram realizadas as dosagens dos biomarcadores: Syndecan-1, Intercellular adhesion molecule-1 (ICAM-1), e-Selectina e Neutrophil gelatinase-associated lipocalin (NGAL). O diagnÃstico de LRA grave foi definido de acordo com a classsificaÃÃo da Kidney Disease Improving Global Outcome (KDIGO) estÃgio 2 ou 3 (duplicaÃÃo dos valores de creatinina sÃrica em relaÃÃo aos valores prÃ-operatÃrios ou necessidade de diÃlise durante internamento). As anÃlises foram ajustadas de acordo um modelo clÃnico de estratificaÃÃo de risco para LRA, com inclusÃo das seguintes variÃveis: idade, sexo, pressÃo arterial sistÃlica na admissÃo na unidade de terapia intensiva (UTI), taxa de filtraÃÃo glomerular prÃ-operatÃria, tipo de cirurgia, uso e tempo de circulaÃÃo extracorpÃrea maior que 120 minutos e componentes do Ãndice de Angina Renal (diminuiÃÃo precoce do clearance de creatinina estimado em relaÃÃo à linha de base e aumento, em porcentagem, do acÃmulo de lÃquido no primeiro dia de pÃs-operatÃrio - PO). Resultados: Syndecan-1 plasmÃtico dosado nas primeiras 2 horas de PO foi independentemente associado com LRA grave. A acurÃcia do Syndecan-1 PO para diagnÃstico de LRA grave foi moderada (Ãrea sob curva ROC de 0,77, IC 95% 0,68 â 0,85). A adiÃÃo do Syndecan-1 melhorou a capacidade discriminatÃria do modelo clÃnico de 0,80 para 0,86 (p=0,004) e tambÃm aumentou a prediÃÃo de risco para LRA, utilizando o Net reclassification improvement (NRI) e o Integrated discrimination improvement (NDI). O Syndecan-1 PO apresentou associaÃÃo direta com os tempos de permanÃncia em unidade de terapia intensiva (UTI) e hospitalar. Os outros marcadores de ativaÃÃo endotelial e o NGAL nÃo apresentam associaÃÃo LRA e nem com outros desfechos clÃnicos. ConclusÃo: Syndecan-1 plasmÃtico està associado com LRA grave subseqÃente e piores desfechos clÃnicos em crianÃas submetidas a cirurgias cÃrdicas. Pode ser um biomarcador precoce Ãtil para identificaÃÃo de pacientes com risco elevado de LRA apÃs cirurgias cardÃacas. |
description |
Background: Acute kidney injury (AKI) is common after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage and its early increment after surgery can be associated with AKI. Objectives: evaluate Syndecan-1 and others biomarkers as predictors of severe AKI after pediatric cardiac surgery. Methods: Prospective cohort study with 289 patients less than 18 years old submitted to cardiac surgery at one reference institution. Postoperative plasma syndecan-1, intercellular adhesion molecule -1 (ICAM-1), e-selectine and neutrophil gelatinase-associated lipocalin (NGAL) were measured within the first 2 hours after cardiac surgery. Severe AKI âdefined according Kidney Disease Improvement Global Outcome (KDIGO) stage 2 or 3- doubling of serum creatinine from the preoperative value or need for dialysis during hospitalization- was the main outcome. Analyses were adjusted for clinical variables for AKI risk stratification, including age, sex, preoperative estimated glomerular filtration rate, type of surgery, use of and cardiopulmonary bypass time longer than 120 minutes and ârenal angina indexâ components - early decrease in estimated creatinine clearance from baseline and increase in % ICU fluid overload in the first day postoperative. Results: Plasma syndecan-1 measured early postoperative was independently associated with severe AKI. The accuracy of postoperative syndecan-1 for diagnosis of severe AKI was moderate (AUC-ROC of 0.77, 95% CI 0.68 â 0.85). The addition of syndecan-1 improved the discrimination capacity of a clinical model from 0.80 to 0.86 (p=0.004) and it also improved risk prediction as measured by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Postoperative sundecan-1 was also independently associated with longer length of ICU and hospital stay. N-GAL, e-selectine and I-CAM -1 were not associated with AKI and other outcomes. Conclusions: Postoperative plasma syndecan-1 is associated with subsequent severe AKI and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for AKI after cardiac surgery. |
publishDate |
2016 |
dc.date.issued.fl_str_mv |
2016-06-06 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/doctoralThesis |
status_str |
publishedVersion |
format |
doctoralThesis |
dc.identifier.uri.fl_str_mv |
http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=17748 |
url |
http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=17748 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
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openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal do Cearà |
dc.publisher.program.fl_str_mv |
Programa de PÃs-GraduaÃÃo em CiÃncias MÃdicas |
dc.publisher.initials.fl_str_mv |
UFC |
dc.publisher.country.fl_str_mv |
BR |
publisher.none.fl_str_mv |
Universidade Federal do Cearà |
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reponame:Biblioteca Digital de Teses e Dissertações da UFC instname:Universidade Federal do Ceará instacron:UFC |
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Biblioteca Digital de Teses e Dissertações da UFC |
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Biblioteca Digital de Teses e Dissertações da UFC |
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Universidade Federal do Ceará |
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UFC |
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UFC |
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mail@mail.com |
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