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Increased numbers of pre-operative circulating monocytes predict risk of developing cardiac surgery-associated acute kidney injury in conditions requiring cardio pulmonary bypass

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Abstract

Background

Evaluating patients’ risk for acute kidney injury (AKI) is crucial for positive outcomes following cardiac surgery. Our aims were first to select candidate risk factors from pre- or intra-operative real-world parameters collected from routine medical care and then evaluate potential associations between those parameters and risk of onset of post-operative cardiac surgery-associated AKI (CSA-AKI).

Method

We conducted two cohort studies in Japan. The first was a single-center prospective cohort study (n = 145) to assess potential association between 115 clinical parameters collected from routine medical care and CSA-AKI (≥ Stage1) risk in the population of patients undergoing cardiac surgery involving cardiopulmonary bypass (CPB). To select candidate risk factors, we employed random forest analysis and applied survival analyses to evaluate association strength. In a second retrospective cohort study, we targeted patients undergoing cardiac surgery with CPB (n = 619) and evaluated potential positive associations between CSA-AKI incidence and risk factors suggested by the first cohort study.

Results

Variable selection analysis revealed that parameters in clinical categories such as circulating inflammatory cells, CPB-related parameters, ventilation, or aging were potential CSA-AKI risk factors. Survival analyses revealed that increased counts of pre-operative circulating monocytes and neutrophils were associated with CSA-AKI incidence. Finally, in the second cohort study, we found that increased pre-operative circulating monocyte counts were associated with increased CSA-AKI incidence.

Conclusions

Circulating monocyte counts in the pre-operative state are associated with increased risk of CSA-AKI development. This finding may be useful in stratifying patients for risk of developing CSA-AKI in routine clinical practice.

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Data availability

The Ethics Committee for Clinical Research at Kumamoto University has placed restrictions on public data sharing because data contain sensitive information.

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Acknowledgements

The authors thank Ms. Kiyoka Tabu and Ms. Kazumi Saito for technical assistance. The authors also thank Kenta Uekihara, M.D., Michiaki Sadanaga, M.D., Michiko Nagamine, M.D., and Masakazu Hamaguchi, CE., on the staff of Japanese Red Cross Kumamoto Hospital, for supporting data collection.

Funding

This study was supported by the Project for Elucidating and Controlling Mechanisms of Aging and Longevity of the Japan Agency for Medical Research and Development (AMED) for Yuichi Oike (Grant: JP19gm5010002), and the Japanese Association of Dialysis Physicians for Jun Morinaga (Grant: 2021-12).

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Authors and Affiliations

  1. Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Yusuke Okadome, Jun Morinaga, Eiji Matsunaga, Hirotaka Fukami, Tsuyoshi Kadomatsu, Haruki Horiguchi, Michio Sato, Taichi Sugizaki & Yuichi Oike

  2. Department of Clinical Engineering, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-ku, Kumamoto, 861-8520, Japan

    Yusuke Okadome

  3. Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Jun Morinaga, Eiji Matsunaga, Hirotaka Fukami, Manabu Hayata, Takashige Kuwabara & Masashi Mukoyama

  4. Department of Clinical Investigation, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Jun Morinaga & Yoshinori Yamanouchi

  5. Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-Minami, Higashi-ku, Kumamoto, 861-8520, Japan

    Takeshi Sakaguchi, Ryo Hirayama & Ryusuke Suzuki

  6. Department of Anesthesiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Tatsuhiro Ishimura & Tatsuo Yamamoto

  7. Medical Information Science and Administration Planning, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Koichiro Usuku

  8. Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Toshihiro Fukui

Authors
  1. Yusuke Okadome
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  2. Jun Morinaga
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  3. Yoshinori Yamanouchi
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  4. Eiji Matsunaga
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  5. Hirotaka Fukami
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  6. Tsuyoshi Kadomatsu
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  9. Taichi Sugizaki
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  16. Tatsuo Yamamoto
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  17. Masashi Mukoyama
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  18. Ryusuke Suzuki
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  19. Toshihiro Fukui
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  20. Yuichi Oike
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Contributions

YO, JM, and YO conceived the idea of the study. YO, JM, and YY conducted data management and statistical analyses. YO, JM, YY, MH, TS, RH, TI, RS, KU, TF and TY contributed to the data collection. YO, JM, EM, HF, TK, HH, MS, TS, MH, MM, and YO contributed to the interpretation of the results. YO, JM, and YO drafted the original manuscript. TK, RS, TF and MM supervised the conduct of this study. All authors reviewed the manuscript draft and revised it critically on intellectual content. All authors approved the final version of the manuscript to be published.

Corresponding authors

Correspondence to Jun Morinaga or Yuichi Oike.

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Okadome, Y., Morinaga, J., Yamanouchi, Y. et al. Increased numbers of pre-operative circulating monocytes predict risk of developing cardiac surgery-associated acute kidney injury in conditions requiring cardio pulmonary bypass. Clin Exp Nephrol 27, 329–339 (2023). https://doi.org/10.1007/s10157-022-02313-x

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