Predictive Value Of Ferroptosis Marker ACSL4 In Acute Renal Injury After Cardiac Surgery

Objective:To verify the relationship between iron death related gene long chain acyl coenzyme A synthase 4（ACSL4）and the incidence of acute renal injury（cardiac surgery associated acute kidney,CSA-AKI）after cardiac surgery.And make clear the predictive value of ACSL4.Method:A total of 60 patients after cardiac surgery admitted to the Department of severe Diseases,the third Clinical Medical College of Shanxi Medical University from June 2022to October 2022 were enrolled.All the patients improved their electrocardiogram,blood routine,liver function and renal function.According to the criteria for improving the global prognosis of kidney disease（Kidney Disease:Improving Global Outcomes,KDIGO）,the level of serum creatinine increased≥26.5μmol/L（≥3 mg/L）within 48 hours after cardiac surgery.Within 7 days after operation,the index increased to≥1.5 times the baseline value,and the urine volume was less than 0.5 ml·kg^-1·h^-1.CSA-AKI can be diagnosed if one of the above three points is met.The patients with AKI within 24 hours after admission were included in the AKI group（n=17）,and the patients without AKI were included in the non-AKI group（n=43）.There were 10 males and 7 females in AKI group,and 20 males and 23 females in non-AKI group,with an average age of 60.88±7.13 years.There was no significant difference in general data between the two groups.The level of ACSL4 was detected by double antibody one-step sandwich enzyme-linked immunosorbent assay（ELISA）.The blood samples were sent to the biochemical laboratory of the other hospital,and the level of SCr was detected by picric acid method.SPSS26.0 is used for statistical analysis,the statistical description of measurement data in accordance with normal distribution is expressed by mean±standard deviation（x±s）,and the statistical description of counting data is expressed by frequency and percentage.Independent sample t test was used to compare the measurement data in accordance with normal data,rank sum test was used to compare measurement data that did not accord with normal data,X²test or Fisher test was used to compare count data between groups,pearson correlation analysis was used to study the correlation,and ROC curve was used to evaluate the diagnostic value of ACSL4 in CSA-AKI.Results:1.The proportion of AKI in cardiac surgery:within 24 hours of admission,17 of 60patients developed AKI,accounting for 28.3%,and 43 cases without AKI,accounting for71.7%.AKI patients were included in AKI group（n=17）,non-AKI patients were included in non-AKI group（n=43）.The age of AKI group was 49-68 years old,and the average age of non-AKI group was 50-68 years old.There was no significant difference in general data between the two groups.2.The ACSL4 value before and after cardiac surgery was not in accordance with the normal distribution,so the rank sum test was used to analyze the validity of the measurement data of ACSL4.The average value of ACSL4 before and after operation was0.242±0.114 in non-CSA-AKI group and 0.239±0.100 after operation,and there was no significant difference in Wilcoxon paired sample rank sum test before and after treatment in CSA-AKI group（0.234±0.143 vs 0.333±0.143,P<0.001）,but there was no significant difference in ACSL4 before and after operation in CSA-AKI group.According to the rank sum test of Man-whttey U samples,there was no significant difference in ACSL4 between the two groups before operation.After operation,the ACSL4 value of AKI group was lower than that of the control group.3.The proportion of patients with increased ACSL4 in control group was 51.16%,that in AKI group was 88.23%,and that in AKI group was higher than that in control group.Chi-square test showed that there was significant difference between the two groups（X²=7.083,P=0.008<0.05）.4.The median and quartile distance of ACSL4 in non-AKI group（control group）were consistent before and after operation,while in patients with AKI after cardiac surgery,the median increased from 0.17 to 0.30,the upper quartile increased from 0.32 to 0.39,and the lower quartile increased from 0.13 to 0.29.5.The results of pearson correlation test showed that ascl4 and SCr were positively correlated with AKI,and the difference was statistically significant.The results of ROC curve showed that the area under the curve of preoperative and postoperative difference of ACSL4 heart to predict the occurrence of postoperative AKI was 0.843（95%CI:0.723～0.963）,the best truncation value was 0.0565,the sensitivity was 82.40%,and the specificity was 83.70%.The area under the curve predicted by the difference of serum SCr before and after operation was 0.878（95%CI:0.768 and 0.989）,the best cutoff value was36.500,the sensitivity was 94.10%and the specificity was 81.40%.The two joint prediction probabilities draw the ROC curve of the combination of two indexes,and the area under the curve is 0.881,95%confidence interval is（0.768,0.994）,indicating that the prediction value of the joint index is greater than that of any single index.Conclusions:ACSL4 is related to the occurrence of AKI after cardiac surgery.ACSL4 can be used as a potential target for prevention and treatment of CSA-AKI.However,the diagnostic value of ACSL4 in CSA-AKI needs to be further studied.