Observational studyPediatric nephrology (Berlin, Germany)2025
Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery.
Observational study in Pediatric nephrology (Berlin, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Novel biomarkers for acute kidney injury in high-risk pediatric populations: a systematic review.Renal failure · 2026Pooled it
- The incidence and risk factors associated with severe acute kidney injury and operative mortality in neonates following cardiac surgery: a single-center experience.Pediatric nephrology (Berlin, Germany) · 2026Article
- Putting the pieces together: solving the puzzle of early acute kidney injury post pediatric cardiac surgery.Pediatric research · 2026Article
- Impact of acute kidney injury and dysnatremia on length of stay in infants after cardiac surgery.Pediatric nephrology (Berlin, Germany) · 2025Article
- Modification of the Cardiac Renal Angina Index for Predicting Adverse Kidney Events After Pediatric Cardiac Surgery.Journal of the American Heart Association · 2025Observational
- Framework for Kidney Health Follow-Up Among Neonates With Critical Cardiac Disease: A Report From the Neonatal Kidney Health Consensus Workshop.Journal of the American Heart Association · 2025Review
- The promise of biomarkers: precision medicine will pave a roadmap for pediatric acute kidney injury management in critically ill children.Intensive care medicine. Paediatric and neonatal · 2025Review
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundPediatric cardiac surgery-associated acute kidney injury (CS-AKI) is common with variable association with outcomes, possibly because transient serum creatinine (SCr) elevations are unrelated to kidney disease. Sub-phenotypes of CS-AKI with biomarker integration may provide prognostic enrichment. This study aims to determine if combining early postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr into sub-phenotypes strengthens associations with AKI and outcomes. We hypothesized that patients with early subclinical (uNGAL + , SCr -) or damage (uNGAL + , SCr +) CS-AKI would have more postoperative day 2-4 KDIGO-defined AKI and worse clinical outcomes than patients with early functional AKI (uNGAL - , SCr +).
methodsTwo-center prospective observational study evaluating combinations of early uNGAL (8-12 h from ICU admission, ≥ 150 ng/mL) and early postoperative (≤ 8 h of admission) KDIGO SCr-defined AKI to predict CS-AKI on postoperative days (POD) 2-4. Four CS-AKI phenotypes were derived (uNGAL - /SCr - ; uNGAL + /SCr - ; uNGAL - /SCr + and uNGAL + /SCr +). The primary outcome was POD2-4 KDIGO SCr-defined CS-AKI. Secondary outcomes included ventilator and intensive care unit-free days (maximum 28).
resultsFour hundred seventy-six patients (median age 4.8 [IQR 1.4-30.4] months, 39% female) were included. POD2-4 AKI occurred in 44 (9.2%). 27% were uNGAL + /SCr - and 0.4% (n = 2) uNGAL + /SCr + . The adjusted odds of POD2-4 AKI was ninefold higher (aOR: 9.09, 95%CI: 3.84-21.53) in uNGAL + /SCr - when compared to uNGAL - /SCr - . uNGAL + /SCr - was associated with fewer ventilator-free (aOR: 0.30, 95%CI: 0.19-0.48) and ICU-free days (aOR: 0.41, 95%CI: 0.26-0.66) when compared to uNGAL - /SCr - .
conclusionEarly postoperative uNGAL, regardless of SCr elevation, refines risk assessment for pediatric POD2-4 CS-AKI and associated morbidity, enabling earlier AKI identification and prognostics.
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