Serum Neutrophil Gelatinase Associated Lipocalin (NGAL) as a Biomarker of Acute Kidney Injury after Cardiac Surgery: A Prospective Cohort Study
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- Category: Vol. 85, September 2017
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Serum Neutrophil Gelatinase Associated Lipocalin (NGAL) as a Biomarker of Acute Kidney Injury after Cardiac Surgery: A Prospective Cohort Study, IHAB A. IBRAHIM, USAMA M. MOHAMED, HUSSEIN H. SAMIR, HOSSAM A. SAYED, EHAB A. HASSAN, MOHAMED S. ABD EL-SALAM and AMAL A. MOHAMMED
Abstract
Introduction: Adult cardiac surgery is significantly asso-ciated with the development of Acute Kidney Injury (AKI). The lack of validated early biomarkers for predicting AKI has hampered our ability to initiate potentially preventive and therapeutic measures in a timely manner. We tested the hy-pothesis that serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) is an early biomarker for AKI after cardiac surgery.
Patients and Methods: We prospectively evaluated 40 adult patients who underwent cardiac surgery. Patients were divided into AKI and non-AKI groups according to whether they developed post-operative AKI within 48h after surgery. Serum NGAL levels were measured 24 hours after surgery. The primary outcome was AKI diagnosed by the Acute Kidney Injury Network (AKIN) criteria.
Results: Twenty-five patients (62.5%) developed AKI after surgery. Mean serum NGAL levels were 1.78±0.3ng/ml 24 hours after cardiopulmonary bypass, with no significant difference between the AKI and non-AKI groups (1.84±0.33 vs 1.69±0.24, p-value=0.136). Univariate analysis showed significant correlation between AKI and the following: Car-diopulmonary Bypass Time (CPB) and Aortic Cross-Clamp time (AXT). Multivariate stepwise logistic regression analysis identified AXT (OR=1.06 [95% CI 1.01-1.12], p=0.02), and CPB (OR=4.6 [95% CI 1.3-16.4], p=0.02), as the only inde-pendent predictors for AKI. Areas under the receiver operating characteristic curve (AUC-ROC) for serum NGAL 24 hours after CPB as a predictor for AKI were 0.663 (95% CI, 0.53 to 0.8), sensitivity was 0.6, and specificity was 0.73 for a cutoff value of 1.8ng/ml.
Conclusion: Serum NGAL had a limited predictive ability for AKI after cardiac surgery and appeared to be more closely related to the use and duration of CPB. Thus, its levels may represent the cumulative effect of an inflammatory response to CPB as well as a renal response to cardiac surgery and inflammation.