Correlation between elevated tnf-α, syndecan-1, and urine il-18 levels in acute kidney injury following on pump cardiac surgery

Objective: This study aims to determine the correlation between elevated tumor necrosis factor alpha (TNF-α) and syndecan-1 with urine interleukin (IL)-18 levels as post-cardiac surgery-related acute kidney injury (AKI) marker. Design: This study was an analytical observa-tional study with a cross sectional design. Setting: This study was conducted at Dr. Wahi-din Sudirohusodo Central General Hospital. The period of study was from October 2019 to February 2020. Patients and participants: Population of study was all patients who underwent adult on pump cardiac surgery. Study samples were patients who were included in inclusion criteria. Pa-tient’s characteristics were presented as fre-quency and percentage. Measurement and results: All interval data with normal distribution were analyzed using T-pair test. Spearman correlation test was performed to determine the correlation between TNF-α, syndecan-1, and IL-18 levels toward AKI inci-dence. The data was presented with odds ratio (OR) 95% confidence interval (CI). There were 33 subjects who underwent adult cardiac surgeries including coronary artery bypass grafting (CABG), valve, and congenital disorder surgeries. Twenty-one people (63.6%) had AKI and 12 people (36.4%) did not. In AKI patients there was an increased syndecan-1 level of 61.94±36.58 ng/ml with relative risk (RR)=1.11 (95% CI 1.02-1.21), TNF-α level of 6.85±4.05 pg/ml, RR=2.61 (95% CI 1.19-5.71), and IL-18 level of 205.5±121.35 pg/ml, RR=1.38 (95% CI 1.06-1.79). There was a significant correlation between syndecan-1, TNF-α, and IL-18 levels. AKI incidence in post-cardiac surgery patients had a significant elevated IL-18 level (p=0.016), with RR=1.38 (95% CI 1.06-1.79). Conclusion: Elevated syndecan-1, TNF-α, and IL-18 levels were correlated with AKI incidence in post-cardiac surgery patients.