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Title: Urinary neutrophil gelatinase-associated lipocalin as predictor of short- or long-term outcomes in cardiac surgery patients
Austin Authors: Garcia-Alvarez, Mercedes;Glassford, Neil J;Betbese, Antoni J;Ordoñez, Jordi;Baños, Victoria;Argilaga, Marta;Martínez, Alfonso;Suzuki, Satoshi;Schneider, Antoine G;Eastwood, Glenn M ;Moral, M Victoria;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Intensive Care Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Department of Biochemistry, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
Issue Date: Dec-2015 2015-05-08
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2016; 29(6): 1480-1488
Abstract: To determine the ability of urinary neutrophil gelatinase-associated lipocalin (uNGAL) to predict cardiac surgery-associated acute kidney injury (CSA-AKI), continuous renal replacement therapy (CRRT), mortality, and a composite outcome of major adverse kidney events at 365 days (MAKE365), and to investigate the influence of cardiopulmonary bypass (CPB) on NGAL release. DESIGN: A prospective observational study. SETTING: A single-center university hospital. PARTICIPANTS: A cohort of 288 adult cardiac surgery patients. INTERVENTIONS: uNGAL was measured at baseline, immediately after surgery, and on days 1 and 2 postoperatively. The authors used the recent Kidney Disease Improving Global Outcomes consensus criteria to define CSA-AKI. MEASUREMENTS AND MAIN RESULTS: CSA-AKI occurred in 36.1% of patients. uNGAL rapidly became significantly higher in patients who developed AKI, with peak value immediately after surgery (349.9 [76.6-1446.6] v 90.1 [20.8-328] ng/mg creatinine; p<0.001). No measure of uNGAL (peak, postsurgery, day 1 or 2 postsurgery) accurately predicted CSA-AKI, CRRT, mortality, or MAKE365. However, immediately after surgery, CPB induced greater uNGAL release compared with off-pump surgery (265.5 µmol/L [71-989.6] v 48.7 ng/mg creatinine [17-129.8]; p<0.001). Moreover, such early uNGAL release correlated with CPB duration (r = 0.505; p<0.001) but not with peak serum creatinine values on day 3 or 7 after surgery. CONCLUSIONS: uNGAL had a limited predictive ability for CSA-AKI or other relevant clinical outcomes after cardiac surgery and appeared to be more closely related to the use and duration of CPB. Thus, its levels may represent the aggregate effect of an inflammatory response to CPB as well as a renal response to cardiac surgery and inflammation.
DOI: 10.1053/j.jvca.2015.05.060
PubMed URL:
Type: Journal Article
Subjects: Acute kidney injury
Cardiac surgery
Cardiopulmonary bypass
Neutrophil gelatinase-associated lipocalin
Urine NGAL
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