Preliminary Communication

Department of Nephrology & Endocrinology, Ernst von Bergmann Hospital Potsdam, Charlottenstr. 72, Potsdam, 14467, Germany

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Berend Isermann

https://orcid.org/0000-0003-0714-6160

Institute of Laboratory Medicine, Leipzig University Hospital, Paul-List-Str. 13/15, Leipzig, 04103, Germany

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Sabine Westphal

https://orcid.org/0000-0002-5846-3345

Institute of Laboratory Medicine, Tertiary Hospital Dessau, Auenweg 38, Dessau-Roßlau, 06847, Germany

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Prasad Devarajan

https://orcid.org/0000-0002-7847-8552

Department of Nephrology & Hypertension, Cincinnati Children’s Hospital, 3333 Burnet Ave, Cincinnati, OH 45229, USA

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Christian Albert

https://orcid.org/0000-0002-6956-9962

Diaverum Renal Care Center, Am Neuen Garten 11, 14469 Potsdam, Germany & Diaverum AB, Hyllie Boulevard 35, Malmö, 21532, Sweden

Medical Faculty, University Clinic for Cardiology & Angiology, Otto von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany

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Hermann Kuppe

Institute of Anesthesiology, German Heart Center, Augustenburger Platz 1, Berlin, 13353, Germany

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Martin Ernst

https://orcid.org/0000-0003-3401-6935

Department of Nephrology & Endocrinology, Ernst von Bergmann Hospital Potsdam, Charlottenstr. 72, Potsdam, 14467, Germany

Medical Faculty, Otto von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany

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Rinaldo Bellomo

https://orcid.org/0000-0002-1650-8939

Department of Intensive Care, Austin Health, 145 Studley Rd, Heidelberg VIC 3084, Melbourne, Australia

Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia

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Michael Haase

*Author for correspondence: Tel.: +49 331 280 6911;

E-mail Address: michael.haase@med.ovgu.de

https://orcid.org/0000-0001-8212-7416

Diaverum Renal Care Center, Am Neuen Garten 11, 14469 Potsdam, Germany & Diaverum AB, Hyllie Boulevard 35, Malmö, 21532, Sweden

Medical Faculty, Otto von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany

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Anja Haase-Fielitz

https://orcid.org/0000-0001-6881-2249

Department of Cardiology, Brandenburg Heart Center, Immanuel Hospital, Ladeburger Str. 17, Bernau, 16321, Germany

Brandenburg Medical School Theodor Fontane, Fehrbelliner Str. 38, Neuruppin, 16816, Germany

Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany

Institute of Social Medicine & Health Care Systems Research, Otto von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany

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Published Online:21 Oct 2021https://doi.org/10.2217/bmm-2021-0283

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Abstract

Aim: To assess the predictive ability of urinary and plasma biomarkers and clinical routine parameters for subsequent severe fluid overload. Patients & methods: In a pilot study, we studied 100 adult patients after cardiac surgery. On intensive care unit admission, we measured biomarkers in urine (midkine, IL-6, neutrophil gelatinase-associated lipocalin [NGAL], hepcidin-25) and plasma (creatinine, urea, B-type natriuretic peptide, lactate, C-reactive protein, leukocytes, IL-6, NGAL, hepcidin-25) to predict postoperative severe fluid overload. Results: Urinary midkine, IL-6, NGAL and hepcidin-25 (all AUCs ≥0.79) predicted postoperative severe fluid overload (n = 5 patients). Urinary NGAL/hepcidin-25 ratio (AUC 0.867) predicted postoperative severe fluid overload after adjustment to EuroScore and need for norepinephrine on surgery day (odds ratio: 2.4). Conclusion: Urinary biomarkers on intensive care unit admission might be helpful to predict subsequent severe fluid overload after cardiac surgery.

Lay abstract

Aim: To assess whether proteins in the urine or blood or clinical routine laboratory parameters can predict severe body fluid overload after cardiac surgery. Patients & methods: In a pilot study, we studied 100 adult patients after cardiac surgery. After surgery, we measured proteins in the urine (midkine, IL-6, neutrophil gelatinase-associated lipocalin [NGAL], hepcidin-25) and blood (creatinine, urea, B-type natriuretic peptide, lactate, C-reactive protein, leukocytes, IL-6, NGAL, hepcidin-25) to predict postoperative severe fluid overload. Results: Urinary midkine, IL-6, NGAL and hepcidin-25 predicted postoperative severe fluid overload (n = 5 patients). Urinary NGAL/hepcidin-25 ratio predicted postoperative severe fluid overload after adjustment to important covariates. Conclusion: Urinary biomarkers might be helpful to predict subsequent severe fluid overload after cardiac surgery.

Tweetable abstract

In a pilot study with 100 adult patients after cardiac surgery, we found that urinary biomarkers, but not blood biomarkers can help predict postoperative severe fluid overload after cardiac surgery.

Graphical abstract

Keywords:

Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 15, No. 16

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Received 9 April 2021

Accepted 12 August 2021

Published online 21 October 2021

Published in print November 2021

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Keywords

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/bmm-2021-0283

Author contributions

S Elitok contributed in conceptualization, data interpretation and validation and the writing of the original draft of the work and review and editing of the work. The data acquisition, formal analysis, investigation, methodology, resources, data interpretation and validation and writing (review and editing the work) were done by B Isermann. S Westphal and P Devarajan helped in data curation, formal analysis, investigation, methodology, resources, data interpretation and validation and writing – review and editing. C Albert and H Kuppe contributed in the data curation, formal analysis, data interpretation and validation and writing – review and editing. The conceptualization, formal analysis, investigation, data interpretation and validation and writing (original draft and review and editing) were done by R Bellomo and A Haase-Fielitz. M Ernst provided support in the formal analysis, investigation, data interpretation and validation and writing (review and editing). M Haase contributed in conceptualization, data curation, formal analysis, investigation, methodology, project administration, resources, supervision, data interpretation and validation and (writing (original draft and review and editing). All authors finally approval the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

The authors thank A Rutenberg and R Rutenberg (German Heart Center Berlin, Germany) for their excellent research assistance.

Financial & competing interests disclosure

This work was supported by grants from the German Heart Foundation (Deutsche Stiftung für Herzforschung) and from the Else Kröner-Fresenius-Stiftung, Germany. The sponsors have not been involved in the study design; the collection, analysis and interpretation of data; the writing of the report; and the decision to submit the article for publication. M Haase has received honoraria speaking for Abbott Diagnostics, Alere, Astute Medical, Biosite, Inc., and Siemens Healthineers. All companies are involved in the development and marketing of renal biomarkers. C Albert has received honoraria speaking for Siemens Healthineers. P Devarajan is a co-inventor on patents submitted for the use of NGAL as a biomarker of kidney disease. Mentioned companies have not been involved in the study design; the collection, analysis and interpretation of data; the writing of the report; and the decision to submit the article for publication. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

This study was conducted in accordance with the World Medical Association Declaration of Helsinki and approved by the Local Institutional Review Board (Charité – University Medicine, Ethics Committee, Berlin, Germany: ZS EK 11 654/07) and reported following the recommendations of the Consolidated Standards of Reporting Trials (CONSORT) group [9]. Written informed consent was obtained from each patient including measurement of biomarkers. The study protocol was approved by the institute's committee on human research.

Data sharing statement

The authors certify that this manuscript reports the secondary analysis of clinical trial data that have been shared with them, and that the use of this shared data is in accordance with the terms agreed upon their receipt. The source of this data is available from the corresponding author upon reasonable request. The type of data that will be shared from submission onwards: deidentified, individual participant data underlying the results presented in the manuscript); study protocol will be available; data will be shared with researchers with a methodologically sound proposal; any analyses to be allowed upon request with the corresponding author.

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Urinary biomarkers to predict severe fluid overload after cardiac surgery: a pilot study

Abstract

Lay abstract

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Graphical abstract

References