Cardiac Biomarkers for Risk Stratification of Acute Kidney Injury after Pediatric Cardiac Surgery.

BACKGROUND: Children undergoing cardiac surgery are at increased risk for acute kidney injury (AKI). Novel biomarkers are needed to improve risk stratification of AKI after cardiac surgery. METHODS: We enrolled children 1 month to 18 years old from July 2007 to December 2010, undergoing cardiopulmonary bypass. Three FDA approved plasma biomarkers of cardiac stretch (N-terminal pro b-type Natriuretic Peptide, NTproBNP), inflammation (ST2), or fibrosis (galectin-3), were measured preoperatively and postoperatively within 6 hours of cardiac surgery. All analyses were stratified by age ( /=2 years old) to account for changing biomarker distributions during childhood and due to a significant interaction between biomarker and age for galectin-3 and NTproBNP (p /=2 years. After multivariable adjustment, for children /=2 years, the highest tertile of preoperative galectin-3 and NTproBNP as well as the postoperative galectin-3 and ST2 were associated with AKI. CONCLUSIONS: Pre-operative plasma galectin-3 and NTproBNP as well as first post-operative galectin-3 and ST2 levels were independently associated with AKI in children >/=2 years old. The performance of cardiac biomarkers after surgery is affected by age and research is required to develop biomarkers for children <2 years old.