| Objective: To investigate the value of circulating mi R-192 in early diagnosis and prognosis of AKI after cardiac surgery.Methods: 1) Blood samples were prospectively collected in patients with cardiac surgery in serial time points. Serum creatinine(Scr) and plasma mi R-192 were examined in 35 patients with AKI and 35 without AKI whose clinical data were similar. The trends of mi R-192 and Scr during the perioperative period in two groups were compared. Receiver operating characteristic(ROC) curves and areas under curves(AUC) were constructed to test the ability of plasma mi R-192 and plasma Cys C to predict AKI. 2) The diagnostic value of plasma mi R-192, plasma Cys C and urine NGAL for AKI were compared. Multiple-stepwise logistic regression analysis were used to analyse risk factors of AKI after cardiac surgery. 3) The level of plasma mi R-192 and Scr were compared in two groups of AKI patients with different outcomes. ROC curves and areas under curves were constructed to test the ability of plasma mi R-192 to predict prognosis of AKI.Results: 1) The cohort was consisted of 70 patients aged(64.31±8.17) years old and baseline Scr of(74.97±16.25) umol/L. Of them, 35 patients were experienced AKI after cardiac surgery. The median time of AKI detected by Scr was 24 hours after admission of ICU. 2) There was no significant difference in plasma levels of mi R-192 between two groups before surgery. Plasma levels of mi R-192 at 0h began to elevate from the baseline [1.12(0.47, 2.42) vs 1.93(0.93, 3.24) and 0.79(0.41, 1.16) vs 1.65(0.97, 2.36) respectively in AKI and non AKI patients, both p<0.05], but with no difference between two groups at 0h post-operation. However, plasma level of mi R-192 continued elevating in AKI patients while began to decline in non-AKI patients at 2h post-operation. The level of mi R-192 in AKI group was significantly higher than that in non-AKI group [1.80(0.94,5.10) vs 1.21(0.88,1.77), P<0.05]. ROC curve analysis showed AUC was 0.67(95%CI: 0.54-0.81, p=0.01). 3) During the perioperative period, the level of plasma Cys C was higher at each timepoints among patients who developed AKI campared with those who did not(1.27±0.38 vs 1.02±0.17 preoperation, 1.13±0.41 vs 0.81±0.19 at 0h post-operation, 1.09±0.37 vs 0.77±0.19 at 2h post-operation and 1.50±0.49 vs 1.03±0.28 at 24 h post-operation in AKI and non AKI patients respectively, all P<0.01). ROC curve analysis showed AUC of plasma Cys C concentration in the diagnosis of AKI was 0.775(95%CI: 0.663 to 0.887, p<0.001) at 0h and 0.808(95%CI: 0.701 to 0.951, P<0.001) at 2h after surgery. 4) For presences of Scr, Cys C and mi R-192, positive correlations were found between each other. 5) Multivariate Logistic regression analysis showed that increased value of mi R-192 at 2 hours after surgery and increased preoperative value of Cys C were two independent risk factors for the ocurrence of AKI. 6) The level of mi R-192 in AKI patients with non-recovery renal function at 7 days after surgery was higher than those with recovery renal function and non-AKI patients during the perioperative period. There were no significant differences in mi R-192 between those with renal function recovery and non-AKI patients during the perioperative period. 7) ROC curve analysis showed AUC of plasma mi R-192 concentration in the diagnosis of AKI prognosis was 0.72(95%CI 0.54 to 0.90, p=0.037) with the sensitivity of 0.77 and specificity of 0.74 for a cutoff value of 2.09 at 2h after surgery. AUC of plasma mi R-192 concentration in the diagnosis of AKI prognosis was 0.86(95%CI 0.72 to 1.00, p=0.001) with the sensitivity of 0.85 and specificity of 0.83 for a cutoff value of 0.52 at 24 h after surgery and AUC of plasma mi R-192 in the diagnosis of AKI prognosis was 0.77(95%CI 0.57-0.96,p=0.021) with the sensitivity of 0.80 and specificity of 0.72 for a cutoff value of 0.67 at 72 h after surgery.Conclusion: The plasma level of mi R-192 were significantly increased early in patients with AKI after cardiac surgery. The circulating mi R-192 at 2h post-operation might be biomarkers for early detection of AKI. Increased value of mi R-192 at 2 h after surgery was an independent risk factor for the ocurrence of AKI. The level of mi R-192 in AKI patients with non-recovery renal function at 7 days after surgrey was higher than those with recovery renal function or non-AKI patients in the early postoperative period. The circulating mi R-192 at 2h post-operation might be an biomarker for prediction of AKI prognosis. |
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