Abstract Type : Poster exhibition
Abstract Submission No.: A-0479
Abstract Topic : Acute Kidney Injury
Prognostic Value of Serum Uric Acid and Ferritin for CSA-AKI in Children
Gulsezim Rakymzhan1, Bolat Bekishev1, Ainamkoz Amanzholova1, Marina Morenko2
1Department of Internal Medicine-Nephrology, Corporate Foundation ''Universal Medical Center" Heart Center, Kazakhstan
2Department of Pediatrics, NJSC "Astana Medical University", Kazakhstan
Objectives : To evaluate the prognostic value of serum uric acid and its perioperative dynamics for the early prediction of cardiac surgery–associated acute kidney injury (CSA-AKI) in children undergoing cardiac surgery, and to compare its diagnostic performance with that of ferritin.
Methods : This prospective cohort study included 148 children aged 0–3 years who underwent elective correction of congenital heart defects with the use of cardiopulmonary bypass. The diagnosis and staging of acute kidney injury (AKI) were performed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Serum uric acid (SUA) levels were measured preoperatively and at 6, 12, 48, and 72 hours postoperatively. Patients were stratified into three groups: no AKI, non-progressive AKI, and progressive AKI (defined as an increase in KDIGO stage and/or the need for peritoneal dialysis). Predictive accuracy was assessed using receiver operating characteristic (ROC) curve analysis.
Results : CSA-AKI developed in 82 (55.4%) patients, of whom 23 (15.5%) exhibited a progressive course. Serum uric acid (SUA) levels were significantly higher in patients with progressive AKI at all postoperative time points (p ≤ 0.006 starting from 12 hours postoperatively). The prognostic value of SUA increased over time: the area under the curve (AUC) was 0.513 at admission, 0.618 at 12 hours, 0.635 at 48 hours, and 0.664 at 72 hours after surgery. Ferritin demonstrated consistently high discriminative ability at all time points (AUC 0.77–0.80), significantly outperforming SUA in predictive performance.
Conclusions : Serum uric acid exhibits time-dependent prognostic value in CSA-AKI in children, with diagnostic accuracy increasing in the postoperative period. Higher SUA levels are associated with progression of kidney injury. Although SUA has lower predictive performance compared with ferritin, it may serve as an additional dynamic biomarker in multimarker risk stratification models.
Methods : This prospective cohort study included 148 children aged 0–3 years who underwent elective correction of congenital heart defects with the use of cardiopulmonary bypass. The diagnosis and staging of acute kidney injury (AKI) were performed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Serum uric acid (SUA) levels were measured preoperatively and at 6, 12, 48, and 72 hours postoperatively. Patients were stratified into three groups: no AKI, non-progressive AKI, and progressive AKI (defined as an increase in KDIGO stage and/or the need for peritoneal dialysis). Predictive accuracy was assessed using receiver operating characteristic (ROC) curve analysis.
Results : CSA-AKI developed in 82 (55.4%) patients, of whom 23 (15.5%) exhibited a progressive course. Serum uric acid (SUA) levels were significantly higher in patients with progressive AKI at all postoperative time points (p ≤ 0.006 starting from 12 hours postoperatively). The prognostic value of SUA increased over time: the area under the curve (AUC) was 0.513 at admission, 0.618 at 12 hours, 0.635 at 48 hours, and 0.664 at 72 hours after surgery. Ferritin demonstrated consistently high discriminative ability at all time points (AUC 0.77–0.80), significantly outperforming SUA in predictive performance.
Conclusions : Serum uric acid exhibits time-dependent prognostic value in CSA-AKI in children, with diagnostic accuracy increasing in the postoperative period. Higher SUA levels are associated with progression of kidney injury. Although SUA has lower predictive performance compared with ferritin, it may serve as an additional dynamic biomarker in multimarker risk stratification models.
ROC curves for Uric Acid and Ferritin.jpg
