Assessment of the reliability of the urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of renal dysfunction after cardiac surgery: A prospective observational study

Czech version

Authors: Gerlichová Monika ¹; Černý Vladimír ¹; Dostál Pavel ¹; Živný Pavel ²
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, LF v Hradci Králové a Fakultní nemocnice Hradec Králové ¹; Ústav klinické biochemie a diagnostiky, Univerzita Karlova v Praze, LF v Hradci Králové a Fakultní nemocnice Hradec Králové ²
Published in: Anest. intenziv. Med., 19, 2008, č. 6, s. 297-303
Category: Anaesthesiology - Original Paper

Overview

Objective:
To assess the reliability of the urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of renal dysfunction after cardiac surgery.

Design:
A prospective observational study.

Setting:
Cardiac surgery ICU, University Hospital.

Materials and Methods:
We evaluated 65 patients who had had cardiac surgery with cardiopulmonary bypass. The exclusion criteria for enrolment in the study were pre-existing renal failure (serum creatinine above 350 μmol/l) requiring haemodialysis, and previous renal transplantation. Urine samples for NGAL analysis by ELISA were collected before incision and for 24 hours post-operatively. Postoperative acute kidney injury (AKI) was defined as 50% or greater increase in serum creatinine from the baseline or 25% or greater decrease in the glomerular filtration rate from the baseline. The statistical analysis was performed using Sigma Stat 3.1. software. The tests used to compare the variables included: The two-sample t-test, the Mann- -Whitney rank sum test, the chi-square test and Fisher’s exact test. A conventional ROC curve was generated to calculate the sensitivity and specificity for the urine NGAL measurement.

Results:
21 of 65 patients (32%) developed postoperative AKI. The urinary NGAL levels and kinetics were equivalent in patients with and without ARF.

Conclusion:
Urinary NGAL is not a reliable marker of renal dysfunction after adult cardiac surgery.

Keywords:
acute kidney injury – cardiopulmonary bypass – markers of renal injury – neutrophil gelatinase-associated lipocalin – glomerular filtration – RIFLE criteria

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Article was published in

Anaesthesiology and Intensive Care Medicine

2008 Issue 6