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Title: Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study.
Austin Authors: Haase-Fielitz, Anja;Bellomo, Rinaldo ;Devarajan, Prasad;Story, David A ;Matalanis, George ;Dragun, Duska;Haase, Michael
Affiliation: Department of Intensive Care, Austin Health, Melbourne, Australia
Issue Date: 1-Feb-2009
Publication information: Critical Care Medicine; 37(2): 553-60
Abstract: To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function.Single-center, prospective observational study.Tertiary hospital.One hundred adult cardiac surgical patients.We measured concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C, and creatinine and urea at baseline, on arrival in the intensive care unit (ICU) and at 24 hours postoperatively. We assessed such biomarkers in relation to the development of AKI (>50% increase in creatinine from baseline) and to a composite end point (need for renal replacement therapy and in-hospital mortality). We defined an area under the receiver operating characteristic curve of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. On arrival in ICU, plasma NGAL and serum cystatin C were of good predictive value, but creatinine and urea were of poor predictive value. After exclusion of patients with preoperative renal impairment (estimated glomerular filtration rate <60 mL/min), the predictive performance for AKI of all renal biomarkers on arrival in ICU remained unchanged except for cystatin C, which was of fair value in such patients. At 24 hours postoperatively, all renal biomarkers were of good predictive value. On arrival in ICU, novel biomarkers were superior to conventional biomarkers (p < 0.05). Plasma NGAL (p = 0.015) and serum cystatin C (p = 0.007) were independent predictors of AKI and of excellent value in the prediction of the composite end point.Early postoperative measurement of plasma NGAL was of good value in identifying patients who developed AKI after adult cardiac surgery. Plasma NGAL and serum cystatin C were superior to conventional biomarkers in the prediction of AKI and were also of prognostic value in this setting.
Gov't Doc #: 19114878
DOI: 10.1097/CCM.0b013e318195846e
Type: Journal Article
Subjects: Acute Kidney Injury.etiology.physiopathology
Acute-Phase Proteins
Aged, 80 and over
Biological Markers.blood
Cardiac Surgical Procedures.adverse effects
Cystatin C.blood
Intensive Care
Intraoperative Complications.prevention & control
Kidney Function Tests
Middle Aged
Predictive Value of Tests
Preoperative Care
Prospective Studies
Proto-Oncogene Proteins.blood
Renal Replacement Therapy
Risk Assessment
Appears in Collections:Journal articles

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