BACKGROUND AKI is an important complication post cardiac surgery in children. An early diagnosis can help in mitigating complications and allow for prognostication. Urinary albumin:creatinine ratio (ACR) as a biomarker can provide a cheaper and more accessible AKI risk assessment and prediction. There is a paucity of paediatric literature regarding its utility. METHODS This was a prospective observational study, enrolling all children aged 1 month to 18 years, who underwent cardiac surgery, with use of cardiopulmonary bypass. Cohort was divided into groups < 2 years and ≥ 2 years for analyses to account for differences in physiological albumin excretion with age. RESULTS Of 143 children enrolled in the study, 36 developed AKI. In both age groups, the post-operative ACR was higher than pre-operative ACR among patients with and without AKI. In the group aged ≥ 2 years, the highest first post-operative ACR tertile (> 75.8 mg/g) predicted post-operative AKI after adjusting for clinical variables (adjusted RR, 11.71; 1.85-16.59). In the group aged < 2 years, the highest first post-operative ACR tertile (> 141.3 mg/g) predicted post-operative AKI in unadjusted analysis but not after adjusting for clinical variables (RR, 2.78; 0.70-6.65). For AKI risk prediction, AUC (95% CI) was highest after combining clinical model and pre-operative ACR for groups aged < 2 years [0.805 (0.713-0.896)] and ≥ 2 years [0.872 (0.772-0.973)]. CONCLUSIONS This study provides evidence for use of albuminuria as a feasible biomarker in AKI prediction in children post cardiac surgery, especially when added to a clinical model. A higher resolution version of the Graphical abstract is available as Supplementary information.

中文翻译：

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围手术期白蛋白尿和预测小儿心脏手术急性肾损伤的临床模型。

背景 AKI 是儿童心脏手术后的重要并发症。早期诊断有助于减轻并发症并进行预测。尿白蛋白：肌酐比 (ACR) 作为生物标志物可以提供更便宜、更容易获得的 AKI 风险评估和预测。关于其效用的儿科文献很少。方法 这是一项前瞻性观察性研究，纳入所有接受心脏手术并使用体外循环的 1 个月至 18 岁儿童。将队列分为< 2 岁和≥ 2 岁的组进行分析，以解释生理白蛋白排泄随年龄的差异。结果 在参加研究的 143 名儿童中，有 36 名发生了 AKI。在两个年龄组中，有和没有 AKI 的患者的术后 ACR 均高于术前 ACR。在年龄≥ 2 岁的组中，在调整临床变量（调整后的 RR，11.71；1.85-16.59）后，最高的第一个术后 ACR 三分位数（> 75.8 mg/g）预测术后 AKI。在年龄 < 2 岁的组中，最高的第一个术后 ACR 三分位数（> 141.3 mg/g）在未经调整的分析中预测了术后 AKI，但在调整了临床变量后却没有（RR，2.78；0.70-6.65）。对于 AKI 风险预测，结合临床模型和术前 ACR 对于年龄 < 2 岁 [0.805 (0.713-0.896)] 和 ≥ 2 岁 [0.872 (0.772-0.973)] 的组，AUC (95% CI) 最高。结论 本研究为使用蛋白尿作为预测儿童心脏手术后 AKI 的可行生物标志物提供了证据，特别是当添加到临床模型中时。