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ASSA13-08-1 Circulating miR-21 Predict Progression of Acute Kidney Injury and Poor Outcomes After Adult Cardiac Surgery
  1. Du Juan1,2,3,
  2. Cao Xiaoqing1,2,3,
  3. Zhou Liang1,2,3,
  4. Zheng Zhe1,2,3,
  5. Hu Shengshou1,2,3
  1. 1State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College
  2. 2Department of Surgery, Fuwai Hospital & Cardiovascular Institute, Chinese Academy of Medical Sciences
  3. 3Key Laboratory of Cardiac Regenerative Medicine, Ministry of Health, National Center for Cardiovascular Diseases

Abstract

Objective Severe acute kidney injury (AKI) after cardiac surgery is significantly associated with increased adverse clinical outcomes. The prognostic utility of current biomarkers is just moderate. We conducted a prospective study to evaluate whether miR-21 can serve as a novel biomarker for postoperative AKI progression.

Methods We measured urine and plasma miR-21 by quantitative real-time PCR in 120 adult patients undergoing cardiac surgery, including 40 non-AKI control, 39 patients with progressed AKI and 41 with non-progressed AKI. The association of miR-21 level with progression of AKI was determined by proper statistical methods.

Results Both urine and blood miR-21 level were up-regulated in patients with AKI and significantly associated with the progression of AKI. The level of urine and plasma miR-21 identified established AKI by AUC 0.68 (95% CI 0.59–0.78) and 0.80 (95% CI 0.73–0.88), respectively. Using multiple logistic regression analysis, we determined the risk of AKI progression. After adjustment for clinical model, the prognostic predictive power of urinary and plasmatic miR-21 increased to AUC 0.81 (95% CI 0.72–0.91) and 0.83 (95%CI 0.74–0.92), respectively. Both urine and plasma miR-21 demonstrated remarkable predictive capability for postoperative need for renal replacement therapy (RRT) with AUC 0.99 (95% CI 0.96 – 1.00, P = 0.003) and 0.97 (95% CI 0.90 –1.00, P = 0.005), 30 day in-hospital mortality and prolonged stay in hospital or ICU after surgery. Compared to plasma miR-21, urine miR-21 performed as a better predictor for associating with a 2.6-fold (95% CI 1.4 – 4.9), 1.7-fold (95% CI 1.3 – 2.3) and 1.6-fold (95% CI 1.3 – 2.0) unadjusted odds for RRT, in-hospital death and development of AKIN stage 3 AKI, respectively.

Conclusions Urinary and plasmatic miR-21 are significantly associated with severe AKI and other poor outcomes of postoperative patients and may be used as promising predictive factors in the field of cardiac surgery.

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