• Fabrizio Monaco, Rosa Labanca, Stefano Fresilli, Gaia Barucco, Margherita Licheri, Giovanna Frau, Paul Osenberg, and Alessandro Belletti.
• Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.. Electronic address: monaco.fabrizio@hsr.it.
• J. Cardiothorac. Vasc. Anesth. 2024 Aug 1; 38 (8): 168916981689-1698.

ObjectivesPrevious studies in other settings suggested that urine output (UO) might affect NephroCheck predictive value. We investigated the correlation between NephroCheck and UO in cardiac surgery patients.DesignPost hoc analysis of a multicenter study.SettingUniversity hospital.ParticipantsPatients who underwent cardiac surgery using cardiopulmonary bypass (CPB) and crystalloid cardioplegia.Measurements And Main ResultsAll patients underwent NephroCheck testing 4 hours after CPB discontinuation. The primary outcome was the correlation between UO, NephroCheck results, and acute kidney injury (AKI, defined according to Kidney Disease: Improving Global Outcomes). Of 354 patients, 337 were included. Median NephroCheck values were 0.06 (ng/mL)2/1,000) for the overall population and 0.15 (ng/mL)2/1,000) for patients with moderate to severe AKI. NephroCheck showed a significant inverse correlation with UO (ρ = -0.17; p = 0.002) at the time of measurement. The area under the receiver characteristic curve (AUROC) for NephroCheck was 0.60 (95% confidence interval [CI], 0.54-0.65), whereas for serum creatinine was 0.82 (95% CI, 0.78-0.86; p < 0.001). When limiting the analysis to the prediction of moderate to severe AKI, NephroCheck had a AUROC of 0.82 (95% CI, 0.77 to 0.86; p<0.0001), while creatinine an AUROC of 0.83 (95% CI, 0.79-0.87; p = 0.001).ConclusionsNephroCheck measured 4 hours after the discontinuation from the CPB predicts moderate to severe AKI. However, a lower threshold may be necessary in patients undergoing cardiac surgery with CPB. Creatinine measured at the same time of the test remains a reliable marker of subsequent development of renal failure.Copyright © 2024 Elsevier Inc. All rights reserved.

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