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Open AccessArticle

Secretory Leukocyte Protease Inhibitor (SLPI)—A Novel Predictive Biomarker of Acute Kidney Injury after Cardiac Surgery: A Prospective Observational Study

1
Department of Intensive Care Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
2
Institute of Human Genetics, Medical Faculty, Heinrich Heine University, 40225 Düsseldorf, Germany
3
Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
4
Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
5
Department of Nephropathology, Yale University School of Medicine, New Haven, CT, 06510, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(11), 1931; https://doi.org/10.3390/jcm8111931
Received: 3 October 2019 / Revised: 1 November 2019 / Accepted: 7 November 2019 / Published: 9 November 2019
Acute kidney injury (AKI) is one of the most frequent complications after cardiac surgery and is associated with poor outcomes. Biomarkers of AKI are crucial for the early diagnosis of this condition. Secretory leukocyte protease inhibitor (SLPI) is an alarm anti-protease that has been implicated in the pathogenesis of AKI but has not yet been studied as a diagnostic biomarker of AKI. Using two independent cohorts (development cohort (DC), n = 60; validation cohort (VC), n = 148), we investigated the performance of SLPI as a diagnostic marker of AKI after cardiac surgery. Serum and urinary levels of SLPI were quantified by ELISA. SLPI was significantly elevated in AKI patients compared with non-AKI patients (6 h, DC: 102.1 vs. 64.9 ng/mL, p < 0.001). The area under the receiver operating characteristic curve of serum SLPI 6 h after surgery was 0.87 ((0.76–0.97); DC). The addition of SLPI to standard clinical predictors significantly improved the predictive accuracy of AKI (24 h, VC: odds ratio (OR) = 3.91 (1.44–12.13)). In a subgroup, the increase in serum SLPI was evident before AKI was diagnosed on the basis of serum creatinine or urine output (24 h, VC: OR = 4.89 (1.54–19.92)). In this study, SLPI was identified as a novel candidate biomarker for the early diagnosis of AKI after cardiac surgery.
Keywords: acute kidney injury; cardiovascular surgery; ICU; complications; biomarkers acute kidney injury; cardiovascular surgery; ICU; complications; biomarkers
MDPI and ACS Style

Averdunk, L.; Fitzner, C.; Levkovich, T.; Leaf, D.E.; Sobotta, M.; Vieten, J.; Ochi, A.; Moeckel, G.; Marx, G.; Stoppe, C. Secretory Leukocyte Protease Inhibitor (SLPI)—A Novel Predictive Biomarker of Acute Kidney Injury after Cardiac Surgery: A Prospective Observational Study. J. Clin. Med. 2019, 8, 1931.

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