TY - JOUR
T1 - Neutrophil gelatinase-associated lipocalin combined with delta serum creatinine provides early risk stratification for adverse outcomes after cardiac surgery: a prospective observational study
AU - McIlroy, David Richard
AU - Farkas, David
AU - Matto, Matthew
AU - Lee, H Thomas
PY - 2015
Y1 - 2015
N2 - Novel biomarkers of renal injury appear inconsistent
in identifying a creatinine-based diagnosis of acute kidney injury.
To be clinically useful, novel acute kidney injury biomarkers should
identify patients at increased risk for adverse outcomes that are a
consequence of acute kidney injury earlier and with greater utility
than conventional creatinine-based metrics. We sought to determine
the prognostic utility of both urinary neutrophil gelatinase?
associated lipocalin and varying creatinine-based metrics of renal
injury at multiple time points associated with cardiac surgery.
Design: Prospective observational study.
Setting: Academic medical center.
Patients: Six hundred three adults undergoing cardiac surgery.
Interventions: Nil.
Measurements and Main Results: Urinary neutrophil gelatinase?
associated lipocalin was measured at baseline and again less
than 1 hour, 3 hours, and 18?24 hours after separation from cardiopulmonary
bypass. Creatinine-based metrics included a Kidney
Disease: Improving Global Outcomes definition of acute kidney
injury through 7 days postoperatively as well as ?SCr-initial, defined
as the incremental change in SCr from baseline to first postoperative
measure. Multivariable regression determined the prognostic
utility of neutrophil gelatinase?associated lipocalin and creatinine,
alone and in combination, for the primary composite outcome of
hospital mortality or renal replacement therapy. The primary outcome
occurred in 25 patients. Adjusted for covariates ?SCr-initial
greater than or equal to 0.0 mg/dL provided early prognostic utility
for the primary outcome (odds ratio, 8.9; 95 CI, 3.0?26.6),
the odds ratio comparable to a creatinine-based Kidney Disease:
Improving Global Outcomes definition of acute kidney injury
applied over 7 days postoperatively. The upper quartile of urinary
neutrophil gelatinase?associated lipocalin best predicted the
primary outcome when measured 18?24 hours post?cardio
AB - Novel biomarkers of renal injury appear inconsistent
in identifying a creatinine-based diagnosis of acute kidney injury.
To be clinically useful, novel acute kidney injury biomarkers should
identify patients at increased risk for adverse outcomes that are a
consequence of acute kidney injury earlier and with greater utility
than conventional creatinine-based metrics. We sought to determine
the prognostic utility of both urinary neutrophil gelatinase?
associated lipocalin and varying creatinine-based metrics of renal
injury at multiple time points associated with cardiac surgery.
Design: Prospective observational study.
Setting: Academic medical center.
Patients: Six hundred three adults undergoing cardiac surgery.
Interventions: Nil.
Measurements and Main Results: Urinary neutrophil gelatinase?
associated lipocalin was measured at baseline and again less
than 1 hour, 3 hours, and 18?24 hours after separation from cardiopulmonary
bypass. Creatinine-based metrics included a Kidney
Disease: Improving Global Outcomes definition of acute kidney
injury through 7 days postoperatively as well as ?SCr-initial, defined
as the incremental change in SCr from baseline to first postoperative
measure. Multivariable regression determined the prognostic
utility of neutrophil gelatinase?associated lipocalin and creatinine,
alone and in combination, for the primary composite outcome of
hospital mortality or renal replacement therapy. The primary outcome
occurred in 25 patients. Adjusted for covariates ?SCr-initial
greater than or equal to 0.0 mg/dL provided early prognostic utility
for the primary outcome (odds ratio, 8.9; 95 CI, 3.0?26.6),
the odds ratio comparable to a creatinine-based Kidney Disease:
Improving Global Outcomes definition of acute kidney injury
applied over 7 days postoperatively. The upper quartile of urinary
neutrophil gelatinase?associated lipocalin best predicted the
primary outcome when measured 18?24 hours post?cardio
UR - http://www.ncbi.nlm.nih.gov/pubmed/25768681
U2 - 10.1097/CCM.0000000000000927
DO - 10.1097/CCM.0000000000000927
M3 - Article
VL - 43
SP - 1043
EP - 1052
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 5
ER -