The role of neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in patients undergoing off-pump coronary artery bypass graft: A pilot study

Background: Acute Kidney Injury (AKI) incidence of postoperative Coronary Artery Bypass Graft (CABG) with Cardipulmonary Bypass (CPB) at Dr. Soetomo General Academic Hospital reached 69.8%, higher than the global average of 5-20%. Predictors of postoperative AKI are needed; potential biomarkers include plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Interleukin-9 (IL-9). This study aims to analyze the predictive ability of these two biomarkers. Methods: This is a prospective observational study in CABG patients with CPB without previous renal abnormalities at Dr. Soetomo in September-December 2020. Examination of plasma NGAL and IL-9 was carried out before, during, and after the CPB procedure. Results: 21 patients were included in the study, 17 people (81.0%) were male. AKI experienced 14 people (66.7%); 3 people (14.3%) died. Patients without AKI had higher plasma NGAL results at preinduction (17.9±10.3 vs 17.1±15.5), durante (20.5±8.2 vs 16.9±7.8), and early ICU (24.0±8.6 vs 22.9±10.4). Patients with AKI had higher plasma IL-9 results at preinduction (63.3±23.2 vs 55.7±15.8), durante (45.2±11.0 vs 44.2±9.2), and early ICU (49.6±11.3 vs 46.2±15.6). There was no statistically significant relationship between plasma NGAL and IL-9 results. Conclusion: Most CABG patients undergoing CPB have AKI. Patients without AKI had higher NGAL results and lower IL-9 in plasma. Statistically, neither of them can be used as predictive biomarkers of the incidence of AKI so far.

Download Full-text

Can urinary neutrophil gelatinase-associated lipocalin have a role in the early diagnosis of acute kidney injury after coronary artery bypass graft?

Journal of Renal Injury Prevention ◽

10.34172/jrip.2020.12 ◽

2020 ◽

Vol 9 (2) ◽

pp. e12-e12

Author(s):

Aiyoub Pezeshgi ◽

Alireza Behmanesh ◽

Abdolreza Esmaeilzadeh ◽

Hossein Chiti ◽

Kurosh Kamali ◽

...

Keyword(s):

Acute Kidney Injury ◽

Artery Bypass ◽

Bypass Graft ◽

Kidney Injury ◽

Coronary Bypass ◽

Urinary Ngal ◽

Artery Bypass Graft ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Post Surgery ◽

Neutrophil Gelatinase

Introduction: The role of urinary neutrophil gelatinase-associated lipocalin (NGAL) as a prognostic biomarker in acute kidney injury (AKI) associated with coronary bypass graft has been suggested in some studies. However, the results have been inconclusive in different studies. Objectives: In the present research, we investigated the diagnostic and prognostic roles of NGAL in Iranian patients who developed AKI after coronary bypass surgery. Patients and Methods: This study was cross-sectional conducted on adult patients undergoing coronary artery bypass graft (CABG) surgery. Postoperative AKI was defined based on the RIFLE (risk, injury, failure, loss and end-stage kidney disease) criteria. Patients were divided into AKI and non-AKI groups. The urinary NGAL and serum creatinine levels were measured at different times after surgery. Results: Out of 29 patients, men constituted 75.9% of cases. Mean age of the patients was 61.4±7.7 years old and the mean duration of surgery was 4.9±0.6 hours. Based on serum creatinine, AKI was diagnosed in 37.9%, 17.25%, and 13.8% of patients at first, second, and third day post-surgery, respectively. The urine NGAL increased by 48.35% and 34.5% at 2 and 6 hours after surgery, respectively. However, there was no significant association between the urinary NGAL level and the incidence of post-surgery AKI. Conclusion: This study showed that urinary NGAL was inapplicable to independently diagnose or predict the outcome of transient AKI associated with CABG.

Download Full-text