Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome

Abstract Aim To determine the association of serum the Neutrophil Gelatinase Associated Lipocalin (NGAL) levels and the need for hemodialysis after percutaneous coronary intervention (PCI).Design This is a prospective, observational study.Setting A cardiovascular and University referral hospital.Patients Patients with Acute Coronary Syndrome (ACS) that underwent PCI, during two consecutive years were enrolled in our study.Main variables of interest NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 hours of hospital admission, and 12 and 24 hours after contrast exposure from angiography. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U Test was used to test for differences in median serum levels of NGAL. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict need for hemodialysis after PCI.Results A total of 2,875 were screened; however, 45 patients with ACS that underwent PCI were included. All patients were at high risk of developing Contrast-induced nephropathy (CIN) defined by Mehran score >11 points. The median (IQR) serum concentration of NGAL was significantly higher in patients that required versus did not require hemodialysis (340 [83-384] vs. 169 [100-210], p=0.01). Elevated serum levels of NGAL predicted the need for hemodialysis with an area under the curve of 0.86 (95% CI: 0.66-1.00).Conclusions In patients with ACS undergoing PCI and high risk of developing CIN, an elevated serum level of NGAL 6 hours after contrast exposure predicts development of acute kidney injury requiring hemodialysis.

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Serum Levels of Neutrophil Gelatinase Associated Lipocalin (NGAL) Predicts Hemodialysis After Coronary Angiography in High Risk Patients with Acute Coronary Syndrome.

10.21203/rs.2.17874/v3 ◽

2020 ◽

Author(s):

Luis Felipe Reyes ◽

Diego Fernando Severiche-Bueno ◽

Carlos A. Bustamante ◽

Sixta Murillo ◽

Nilam J. Soni ◽

...

Keyword(s):

Acute Kidney Injury ◽

High Risk ◽

Elevated Serum ◽

Kidney Injury ◽

Serum Levels ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Coronary Syndrome ◽

Risk Patients ◽

Contrast Exposure ◽

Neutrophil Gelatinase

Abstract Background: Contrast-induced nephropathy (CIN) following a percutaneous coronary intervention (PCI) is the third most common cause of acute kidney injury (AKI) worldwide. Patients who require hemodialysis secondary to CIN have an elevated mortality rate as high as 55%. The current definition of CIN is based on an elevation of creatinine and decrease in urinary output. Creatinine typically increases 48 hours after the contrast exposure, which delays the diagnosis and treatment of CIN. The neutrophil gelatinase associated lipocalin (NGAL) has emerged as a sensitive and specific biomarker of renal injury. Limited data exists about the effectiveness of NGAL to predict CIN in high-risk patients with acute coronary syndrome (ACS) that underwent PCI. The primary aim of this study was to determine the association of serum NGAL levels and the need for hemodialysis after PCI. Methods: This is a prospective, observational study. NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 hours of hospital admission, and 12 and 24 hours after contrast exposure from angiography. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U test was used to test for differences in median serum levels of NGAL. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict the need for hemodialysis after PCI. Results: A total of 2,875 were screened; however, 45 patients with ACS that underwent PCI were included. All patients were at high risk of developing CIN defined by Mehran score >11 points. The median (IQR) serum concentration of NGAL was significantly higher in patients that required versus did not require hemodialysis (340 [83-384] vs. 169 [100-210], p=0.01). Elevated serum levels of NGAL with a cut-off at 6 hours post PCI of 281 mg/dL predicted the need for hemodialysis with an area under the curve of 0.86 (95% CI: 0.66-1.00). Conclusions: In patients with ACS undergoing PCI; and high risk of developing CIN, an elevated serum level of NGAL 6 hours after contrast exposure predicts the development of acute kidney injury requiring hemodialysis.

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