This single-center cohort included 3,415 adult cardiac surgery patients over six years and evaluated liver enzymes as predictors of postoperative acute kidney injury. Overall, 65.4% developed acute kidney injury, 37.4% had stage ≥2 injury, and 3.8% received renal replacement therapy. Admission AST normalized to the upper limit of normal showed weak discrimination for acute kidney injury: AUC 0.587 (95% CI 0.570–0.604). AST measured 12 hours after ICU admission was the strongest reported predictor of renal replacement therapy, with an AUC of 0.751 (95% CI 0.733–0.768).
Admission liver enzymes offered limited discrimination for postoperative kidney injury. The stronger predictive signal for renal replacement therapy at 12 hours warrants further validation before clinical application.
Study limitation: The single-center observational design limits generalizability and cannot establish that liver enzyme elevations cause kidney injury.
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