Risk factor and correlation between postoperative serum myoglobin and acute kidney injury after pulmonary endarterectomy

Mingyuan Xu; Yanan Zhen; Zhaohua Zhang; Xia Zheng; Xiaopeng Liu; Jingwen Liu; Liang Yang; Zhidong Ye; Jianyan Wen; Peng Liu

doi:10.21037/jtd-23-1510

Risk factor and correlation between postoperative serum myoglobin and acute kidney injury after pulmonary endarterectomy

J Thorac Dis. 2024 Feb 29;16(2):1074-1086. doi: 10.21037/jtd-23-1510. Epub 2024 Feb 26.

Authors

Mingyuan Xu^#^{1

2}, Yanan Zhen^#^{1

2}, Zhaohua Zhang^{1

2}, Xia Zheng², Xiaopeng Liu², Jingwen Liu^{1

2}, Liang Yang^{2

3}, Zhidong Ye², Jianyan Wen², Peng Liu^{1

2}

Affiliations

¹ Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
² Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China.
³ China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

^# Contributed equally.

Abstract

Background: Acute kidney injury (AKI) is a common and life-threatening complication following pulmonary endarterectomy (PEA). Our study aimed to investigate the risk factors associated with AKI and evaluate the correlation between serum myoglobin (sMb) levels and postoperative AKI.

Methods: We conducted a retrospective study involving 134 patients who underwent PEA at China-Japan Friendship Hospital. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results: During the study period, the incidence of postoperative AKI was 57.5%, and the associated mortality rate was 6.0%. Severe AKI was found to be significantly associated with worse short-term outcomes (P<0.05). Logarithmically transformed postoperative day (POD) 0 sMb levels were significantly associated with AKI [odds ratio (OR) =5.174; 95% confidence interval (CI), 2.307-11.603; P<0.001] and severe AKI (OR =4.605; 95% CI, 1.510-14.048; P=0.007), also had independent predictive value [area under the curve (AUC) =0.776 in AKI and AUC =0.737 in severe AKI]. The optimal cut-off values were 370.544 ng/mL for AKI and 419.473 ng/mL for severe AKI. Furthermore, albumin concentration was found to play a protective role in the development of severe AKI (OR =0.838; 95% CI, 0.716-0.980; P=0.027) when higher than 40.350 g/L.

Conclusions: Our findings suggest that a high concentration of POD0 sMb may increase the risk of developing AKI following PEA surgery. Increasing albumin concentration could serve as an effective preventive measure against AKI.

Keywords: Acute kidney injury (AKI); myoglobin; pulmonary endarterectomy (PEA).