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

Mercedes Garcia-Alvarez, Neil John Glassford, Antoni J Betbese, Jordi Ordonez, Victoria Banos, Marta Argilaga, Alfonso Martinez, Satoshi Suzuki, Antoine Guillaume Schneider, Glenn M Eastwood, Ma Victoria Moral, Rinaldo Bellomo

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Abstract

Objectives 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.

Original languageEnglish
Pages (from-to)1480-1488
Number of pages9
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume29
Issue number6
DOIs
Publication statusPublished - 1 Dec 2015

Keywords

  • acute kidney injury
  • biomarker
  • cardiac surgery
  • cardiopulmonary bypass
  • neutrophil gelatinase-associated lipocalin
  • urine NGAL

Cite this

Garcia-Alvarez, Mercedes ; Glassford, Neil John ; Betbese, Antoni J ; Ordonez, Jordi ; Banos, Victoria ; Argilaga, Marta ; Martinez, Alfonso ; Suzuki, Satoshi ; Schneider, Antoine Guillaume ; Eastwood, Glenn M ; Moral, Ma Victoria ; Bellomo, Rinaldo. / Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients. In: Journal of Cardiothoracic and Vascular Anesthesia. 2015 ; Vol. 29, No. 6. pp. 1480-1488.
@article{34a461c2a8f24c13b3e1ab71db7e964e,
title = "Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients",
abstract = "Objectives 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.",
keywords = "acute kidney injury, biomarker, cardiac surgery, cardiopulmonary bypass, neutrophil gelatinase-associated lipocalin, urine NGAL",
author = "Mercedes Garcia-Alvarez and Glassford, {Neil John} and Betbese, {Antoni J} and Jordi Ordonez and Victoria Banos and Marta Argilaga and Alfonso Martinez and Satoshi Suzuki and Schneider, {Antoine Guillaume} and Eastwood, {Glenn M} and Moral, {Ma Victoria} and Rinaldo Bellomo",
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Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients. / Garcia-Alvarez, Mercedes; Glassford, Neil John; Betbese, Antoni J; Ordonez, Jordi; Banos, Victoria; Argilaga, Marta; Martinez, Alfonso; Suzuki, Satoshi; Schneider, Antoine Guillaume; Eastwood, Glenn M; Moral, Ma Victoria; Bellomo, Rinaldo.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 29, No. 6, 01.12.2015, p. 1480-1488.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients

AU - Garcia-Alvarez, Mercedes

AU - Glassford, Neil John

AU - Betbese, Antoni J

AU - Ordonez, Jordi

AU - Banos, Victoria

AU - Argilaga, Marta

AU - Martinez, Alfonso

AU - Suzuki, Satoshi

AU - Schneider, Antoine Guillaume

AU - Eastwood, Glenn M

AU - Moral, Ma Victoria

AU - Bellomo, Rinaldo

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives 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.

AB - Objectives 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.

KW - acute kidney injury

KW - biomarker

KW - cardiac surgery

KW - cardiopulmonary bypass

KW - neutrophil gelatinase-associated lipocalin

KW - urine NGAL

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U2 - 10.1053/j.jvca.2015.05.060

DO - 10.1053/j.jvca.2015.05.060

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VL - 29

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EP - 1488

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 6

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