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Title: Urinary neutrophil gelatinase-associated lipocalin-guided risk assessment for major adverse kidney events after open-heart surgery.
Austin Authors: Albert, Christian;Albert, Annemarie;Bellomo, Rinaldo ;Kropf, Siegfried;Devarajan, Prasad;Westphal, Sabine;Baraki, Hassina;Kutschka, Ingo;Butter, Christian;Haase, Michael;Haase-Fielitz, Anja
Affiliation: Institute of Social Medicine & Health Economics, Otto-von-Guericke University, Magdeburg, ST, Germany
Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, BB, Germany
Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany
Diaverum Deutschland, Potsdam, BB, Germany
School of Medicine, Intensive Care Unit, Austin Hospital, Heidelberg, VIC, 3084 Australia
Institute of Laboratory Medicine, Hospital Dessau, Dessau, ST, Germany
Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany
Institute for Biometrics & Medical Informatics, Otto-von-Guericke University, Magdeburg, ST, Germany
Division of Nephrology & Hypertension, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
Department of Thoracic, Cardiac & Vascular Surgery, University of Göttingen, Göttingen, NI, Germany
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Sep-2018 2018-08-08
Publication information: Biomarkers in medicine 2018; 12(9): 975-985
Abstract: To assess weather doctors' clinical risk-assessment for major adverse kidney events (MAKE) and acute kidney injury (AKI) after open-heart surgery would improve when being informed about neutrophil gelatinase-associated lipocalin (NGAL) test result at ICU admission. Clinical risk-assessment for MAKE and AKI were performed with and without providing NGAL test result and compared in an exploratory- and a validation-cohort using reclassification metrics, exemplary category-free net reclassification improvement (cfNRI). Exploratory cohort: doctors' prediction of MAKE (cfNRI = 0.750 [0.130-1.370]; p = 0.018) and AKI (cfNRI = 0.565 [0.001-1.129]; p = 0.049) improved being provided with NGAL test information. This finding was confirmed in the validation-cohort (MAKE cfNRI = 0.930 [0.188-1.672]; p = 0.014) and the combined-cohort (MAKE: cfNRI = 0.847 [0.371-1.323], p < 0.001); AKI: cfNRI = 0.468 [0.099-0.836; p = 0.013]). Improvements mostly generated from correctly reclassifying patients who not developed events (p < 0.001). Biomarker informed risk-assessment is superior in predicting MAKE and AKI after open-heart surgery.
DOI: 10.2217/bmm-2018-0071
PubMed URL: 30088425
Type: Journal Article
Subjects: acute kidney injury (AKI)
cardiac surgery
major adverse kidney events (MAKE)
neutrophil gelatinase-associated lipocalin (NGAL)
risk prediction
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