Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients

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• 作者：Mercedes Garcia-Alvarez ; MD^* ; ^&dagger ; ; ^{merchuki2000@yahoo.es" class="auth_mail" title="E-mail the corresponding author} ; ^{mgarciaa@santpau.cat" class="auth_mail" title="E-mail the corresponding author} ; Neil J. Glassford ; MBChB ; MRCP^* ; ^&Dagger ; ; Antoni J. Betbese ; MD ; PhD^§ ; ; Jordi Ordoñ ; ez ; MD ; PhD^¶ ; ; Victoria Bañ ; os ; MD^&dagger ; ; Marta Argilaga ; MD^&dagger ; ; Alfonso Martí ; nez ; MD ; PhD^&dagger ; ; Satoshi Suzuki ; MD ; PhD^* ; Antoine G. Schneider ; MD^* ; Glenn M. Eastwood ; BN ; PhD^* ; M. Victoria Moral ; MD^&dagger ; ; Rinaldo Bellomo ; MD^* ; ^&Dagger ; ; ^‖
• 关键词：acute kidney injury ; cardiac surgery ; cardiopulmonary bypass ; neutrophil gelatinase-associated lipocalin ; urine NGAL ; biomarker
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：29
• 期：6
• 页码：1480-1488
• 全文大小：712 K

文摘

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.