Objective:

To investigate the association between circulating biomarkers of endothelial glycocalyx degradation and postoperative acute kidney injury in patients undergoing cardiac surgery with cardiopulmonary bypass.

Approach:

• Study Design: Single-center retrospective observational study including 152 patients who underwent cardiac surgery with cardiopulmonary bypass.
• Biomarker Measurement: Syndecan-1, hyaluronic acid, and heparan sulfate were measured before and at the end of cardiopulmonary bypass.
• AKI Definition: Postoperative acute kidney injury was defined according to the Kidney Disease: Improving Global Outcomes criteria.
• Statistical Analysis: Between-group comparisons, paired analyses, logistic regression, and receiver operating characteristic analysis were performed.

Key Findings:

• Postoperative acute kidney injury occurred in 43 of 152 patients, with an incidence of 28.3%.
• Patients with acute kidney injury were older and had worse baseline renal function.
• Syndecan-1 and heparan sulfate levels were higher in the acute kidney injury group at the end of cardiopulmonary bypass, whereas hyaluronic acid did not differ significantly between groups.
• Syndecan-1 showed the best discriminatory performance among the biomarkers, with an area under the curve of 0.743.

Interpretation:

Limitations:

• Single-center study may limit generalizability.
• Retrospective design may introduce bias.

Conclusion:

Syndecan-1 measured at the end of cardiopulmonary bypass is associated with postoperative acute kidney injury and shows the best discriminatory performance among the biomarkers evaluated.