Identification of Plasma Metabolites Prognostic of Acute Kidney Injury after Cardiac Surgery with Cardiopulmonary Bypass

Acute kidney injury (ART) is a frequent complication after cardiopulmonary bypass, but early detection of postoperative ART remains challenging. Protein biomarkers predict AKI excellently in homogeneous cohorts but are less reliable in patients suffering from various comorbidities. We employed nuclear magnetic resonance spectroscopy in a prospective study of 85 adult cardiac surgery patients to identify metabolites prognostic of AKI in plasma specimens collected 24 h after surgery. Postoperative AKI of stages 1-3, as defined by the Acute Kidney Injury Network (AKIN), developed in 33 cases. A random forests classifier trained on the NMR spectra prognosticated AKI across all stages, with an average accuracy of 80 +/- 0.9% and an area under the receiver operating characteristic curve of 0.87 +/- 0.01. Prognostications were based, on average, on 24 +/- 2.8 spectral features. Among the set of discriminative ions and molecules identified were Mg2+, lactate, and the glucuronide conjugate of propofol. Using creatinine, Mg2+, and lactate levels to derive an AKIN index score, we found AKIN 1 disease to be largely indistinguishable from AKIN 0, in concordance with the rather mild nature of AKIN 1 disease.