Acute kidney injury (AKI) is a common and serious clinical syndrome after cardiac surgery with the high morbidity and mortality.As the markers of AKI,Serum creatinine and urine output is not sensitive for early detection.Due to the lack of early biomakers for AKI,early effective treatment has been delayed.Identification of novel biomarkers for AKI has progressed to the clinical phase.Novel biomakers include neutrophil gelatinase-associated lipocalin,kidney injury molecule-1,Cystatin C,IL-18,and so on.In this article the author will review the current progress of these clinical and experimental novel AKI biomarkers.

Objective To investigate the correlation of possible risk factors with acute renal injury (AKI) after coronary artery bypass surgery (CABG) and explore if the incidence of AKI could be lower by off-pump CABG for kidney protection.Methods Two hundred and nine patients who underwent coronary artery bypass surgery in Nanjing First Hospital from September 2010 to November 2013 were recruited.The patients were divided into AKI group (fifty-five cases) and non-AKI group (one hundred and fifty-four cases) according to the AKI criteria and compared the possible risk factors between two the groups by univariate analysis and multivariate analysis.Results The index of female gender,body mass index,age,hypertension,basic serum creatinine,ejection fraction,the number of coronary atherosclerosis,cardiopulmonary bypass,IABP for circulatory support,postoperative low cardiac output,lactate in AKI group were higher than that in non-AKI group by univariate analysis (P ＜ 0.05).And basic serum creatinine,ejection fraction,cardiopulmonary bypass,postoperative low cardiac output showed a significantly statistical difference between two group by multivariate analysis.Conclusions Cardiopulmonary bypass,basic serum creatinine,ejection fraction,postoperative low cardiac output were independent risk factors.Off-pump CABG could benefit for kidney protection.

Objective To test the hypothesis that interleukin-18 (IL-18) in the urine and serum sample are early biomarker for acute kidney injury (AKI) in patients after coronary artery bypass graft surgery (CABG).Methods Eighty patients who underwent CABG were recruited.The patients were divided into AKI group and non-AKI group according to the AKI criteria.The urine and serum sample were collected at pre-operation and 2 h,4 h,6 h,8 h,12 h,24 h after the CABG.The urine and serum IL-18 value were test by ELISA method.Receiver-operating characteristic cue(ORC) and the area under the cure(AUC) asses the sensitivity and specificity of IL-18 for AKI.Results Thirteen of eighty cases(16.25％) developed postoperative AKI according to the AKI criteria.Diagnosis with creatinine was only 24-48 hours after CABG.The serum and urinary concentrations of IL-18 at mostly each time point after CABG in AKI patients were significantly higher than those in non-AKI patients(P ＜ 0.01).Urinary and serous concentrations of IL-18 peaked at 4 h after CABG in AKI patients.ROC curve showed AUC in urinary and serous concentrations of IL-18 at 2 h ＞ 0.8 ; Concentrations of IL-18 in urine and serum at 2 h were the powerful independent predictors of AKI by logistic regression analysis.Conclusion IL-18 in urine and serum after CABG surgery were the powerful independent predictors of AKI.

Objective: To explore the relationship between the change of blood cholesterol and prognosis in patients with sepsis. Methods: The clinical data of 236 patients with sepsis (observation group) admitted to Nanjing Hospital Affiliated to Nanjing Medical University from February 2014 to December 2018 were analyzed retrospectively.The general clinical data, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) of the two groups were compared with 236 patients without sepsis in the same period as the control group, high density lipoprotein cholesterol (HDL-C) and other biochemical indexes; sepsis patients were divided into survival group and death group according to the prognosis, and the related factors affecting the prognosis were analyzed by multi factor Logistic regression. Results: The survival rate of sepsis patients was 60.6% (143/236), the mortality rate was 39.4% (93/236), 143 cases in survival group and 93 cases in death group.Compared with control group, the levels of serum TC ((2.51±1.20) mmo/L vs.(3.42±1.33) mmo/L, t=6.385) and HDL-C ((1.62±0.91) mmo/L vs.(2.53±0.79) mmo/L, t=5.526) in observation group were significantly lower (all P<0.05), and that of LDL-C showed no statistically significant difference((1.95±0.93) mmo/L vs.(2.11±0.84) mmo/L, t=0.958, P>0.05). In observation group, the patients in death group were older than those of the survival group ((75.4±10.3) years vs.(64.3±16.0) years, t=4.984, P<0.05), serum creatinine (SCr) was higher than that of survival group((252.3±65.2) μmol/L vs.(168.3±47.8) μmol/L, t=5.604, P<0.05), the levels of serum TC ((2.20±1.46) mmo/L vs.(2.91±1.12) mmo/L, t=6.157, P<0.05), HDL-C ((1.41±0.51) mmo/L vs.(1.95±0.65) mmo/L, t=5.090, P<0.05) and LDL-C ((1.71±0.67) mmo/L vs.(2.02±0.84) mmo/L, t=4.525, P<0.05) were significantly lower than those of survival group.Logistic regression analysis showed that age was the risk factor of death in sepsis patients (OR=1.035, 95%CI 1.012-1.049, P=0.008), and TC was the protective factor on the prognosis of sepsis patients (OR=0.748, 95%CI 0.693-0.822, P=0.015). Conclusion TC and HDL-C were significantly decreased in sepsis patients, while those who died were further decreased than those who survived.As a protective factor TC can be an effective biochemical index to evaluate the prognosis of patients with sepsis.

Objective To explore left ventricular longitudinal systolic function changes during perioperative period of coronary artery bypass graft(CABG).Methods Totally 41 patients with confirmed coronary artery disease(CAD)who underwent CABG were prospectively enrolled.The preoperative left ventricular global longitudinal strain(GLS),as well as GLS on the day of CABG,on the 3rd and 7th day postoperation were measured.According to preoperative left ventricular GLS,the patients were divided into 3 groups,i.e.normal group(group A,GLS≤-18.1％,n=6),mildly decreased group(group B,-18.1％＜GLS≤-14.0％,n=22)and severely decreased group(group C,GLS＞-14.0％,n=13).Repeated measures analysis of variance,generalized estimating equation and multiple comparisons were used to analyze left ventricular systolic function in different perioperative time points.Results No significant difference of GLS was found among different time points during perioperative period of CABG in group A and C(all adjusted P＞0.05).In group B,GLS on postoperative days were lower than that before CABG(all adjusted P＜0.001),and the lowest value was observed on the day of CABG postoperatively,while no significant difference of GLS was found between the 3rd and 7th day postoperation(adjusted P=1.00).Compared with those before CABG,the longitudinal strain(LS)of basal segment on the day of CABG postoperatively and 3rd day postoperation,of middle segment and apical segment at all postoperative time points were lower(all adjusted P＜0.05),while of the apical segment on the day of CABG postoperatively decreased most obviously.No significant difference of LS of each ventricular segment was found between the 3rd nor the 7th day postoperation(all adjusted P＞0.05).Conclusion GLS decreased significantly on the day of CABG postoperatively but partially recovered within the following week in CAD patients with mildly decreased preoperative GLS.CABG had the most pronounced effect on LS of apical segment in left ventricle.

Objective     To investigate the early diagnostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) for acute kidney injury (AKI) after acute Stanford type A aortic dissection. Methods     From January 2018 to December 2018, the clinical data of 50 patients who underwent open surgery for acute Stanford type A aortic dissection were analyzed in Nanjing First Hospital. Urine specimens were collected before and 2 hours after the aortic dissection surgery. Patients were divided into an AKI group (n=27) and a non-AKI group (n=23) according to the Kidney Disease Improving Global Outcomes criteria. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of urine NGAL.  Results    The incidence of postoperative AKI was 54.00% (27/50). There was a statistically significant difference between the two groups in serum creatinine concentration at 2 hours after surgery and urinary NGAL concentration before the surgery (P<0.05). The area under ROC curve of preoperative urinary NGAL concentration was 0.626. When cut-off value was 43 ng/mL, the sensitivity was 40.7%, specificity was 95.7%. The area under ROC curve of urinary NGAL concentration at 2 hours after surgery was 0.655, and when the cut-off value was 46.95 ng/mL, the sensitivity was 63.0%, specificity was 78.3%.  Conclusion     Urine NGAL can predict postoperative AKI in patients with acute Stanford type A aortic dissection, but its value is limited.