Comparative evaluation of urinary NGAL and perioperative factors in predicting adverse outcomes of acute kidney injury in cardiac surgery in elderly patients
Abstract
Urinary NGAL levels may be a valid predictor of acute kidney injury (AKI) and cardiac surgery outcomes. The aim of the study was a comparative evaluation of urine NGAL and factors in cardiovascular surgery as a predictor of adverse outcome AKI in elderly patient after cardiac surgery. A prospective cohort study was performed in 81 patients 65 to 80 years. Researching material was urine from catheter immediately before surgery and 4 hours after cardiac surgery. Analysis of NGAL in urine was performed by quantifying immuno-hemilumiscest method. In a result ROC-analysis showed that the level of postoperative urinary NGAL is an early marker of AKI after cardiac surgery in elderly patients (AUC 0,75; 93% CI 0,60–0,90). The time of surgery and cardiopulmonary bypass are the main factors in predicting dialysis-dependent AKI (AUC 0,86, 95% CI 0,75–0,97; AUC 0,85, 95% CI 0,75–0,95, respectively). Urinary NGAL is a useful predictor of duration RRT above 5 days in elderly patients undergoing cardiac surgery with AKI (AUC 0,89, 93% CI 0,64–1,0). Determination of urinary NGAL may be useful in predicting death in the postoperative period of cardiac surgery in elderly patients (AUC 0,82, 94% CI 0,69–0,95).
About the Authors
S. V. Kolesnikov
Meshalkin State Research Institute of Circulation Pathology, Novosibirsk
Russian Federation
Russian Federation
A. S. Borisov
Meshalkin State Research Institute of Circulation Pathology, Novosibirsk
Russian Federation
Russian Federation
References
1. Малов А., Мухоедова Т. Прогноз летальных исходов при диализ-зависимом почечном повреждении после кардиохирургических вмешательств // Патология кровообращения и кардиохирургия. 2012. № 2. С. 65–69.
2. Мухоедова Т., Ломиворотов В., Колесников С. и др. Предикторы исходов острой почечной недостаточности при заместительной почечной терапии у кардиохирургических больных // Анестезиология и реаниматология. 2005. № 2. С. 53–58.
3. Bellomo R., Ronco C., Kellum J. et al. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) // Group. Crit. Care. 2004. Vol. 8. № 4. P. 204–212.
4. da Silva Magro M., de Fatima Fernandes Vattimo M. Does urinalysis predict acute renal failure after heart surgery? // Ren. Fail. 2004. Vol. 26. № 4. P. 385–392.
5. Haase M., Bellomo R., Devarajan P. et al. Novel biomarkers early predict the severity of acute kidney injury after cardiac surgery in adults // Ann. Thorac. Surg. 2009. Vol. 88. № 1. P. 124–130.
6. Haase M., Bellomo R., Devarajan P. et al. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis // Am. J. Kidney Dis. 2009. Vol. 54. № 6. P. 1012–1024.
7. Han W., Wagener G., Zhu Y. et al. Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery // Clin. J. Am. Soc. Nephrol. 2009. Vol. 4. № 5. P. 873–882.
8. Mehta R., Kellum J., Shah S. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury // Crit. Care. 2007. Vol. 11. № 2. P. 31.
9. Liangos O., Tighiouart H., Perianayagam M. et al. Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass // Biomarkers. 2009. Vol. 14. № 6. P. 423–431.
10. Mishra J., Ma Q., Prada A. et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury // J. Am. Soc. Nephrol. 2003. Vol. 14. № 10. P. 2534–2543.
11. O'Hare A., Walker R., Haneuse S. et al. Relationship between longitudinal measures of renal function and onset of dementia in a community cohort of older adults // J. Am. Geriatr. Soc. 2012. Vol. 60. № 12. P. 2215–2222.
12. Parikh C., Devarajan P., Zappitelli M. et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery // J. Am. Soc. Nephrol. 2011. Vol. 22. № 9. P. 1737–1747.
13. Parikh C., Mishra J., Thiessen-Philbrook H. et al. Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery // Kidney Int. 2006. Vol. 70. № 1. P. 199–203.
14. Sargentini V., Mariani P., D' Alessandro M. et al. Assessment of NGAL as an early biomarker of acute kidney injury in adult cardiac surgery patients // J. Biol. Regul. Homeost. Agents. 2012. Vol. 26. № 3. P. 485–493.
15. Tuttle K., Worrall N., Dahlstrom L. et al. Predictors of ARF after cardiac surgical procedures // Am. J. Kidney Dis. 2003. Vol. 41. № 1. P. 76–83.
16. Vaidya V., Waikar S., Ferguson M. et al. Urinary biomarkers for sensitive and specific detection of acute kidney injury in humans // Clin. Transl. Sci. 2008. Vol. 1. № 3. P. 200–208.
17. Wagener G., Jan M., Kim M. et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery // Anesthesiology. 2006. Vol. 105. № 3. P. 485–491.
18. Wijeysundera D., Karkouti K., Dupuis J. et al. Derivation and validation of a simplified predictive index for renal replacement therapy after cardiac surgery // 2007. JAMA. 2007. Vol. 297. № 16. P. 1801–1809.
19. Zanardo G., Michielon P., Paccagnella A. et al. Acute renal failure in the patient undergoing cardiac operation. Prevalence, mortality rate, and main risk factors // J. Thorac. Cardiovasc. Surg. 1994. Vol. 107. № 6. P. 1489–1495.
Review
For citations:
Kolesnikov S.V., Borisov A.S. Comparative evaluation of urinary NGAL and perioperative factors in predicting adverse outcomes of acute kidney injury in cardiac surgery in elderly patients. Nephrology and Dialysis. 2013;15(3):216-220. (In Russ.)
Views:
28
Email this article 