NGAL Usefulness in the Intensive Care Unit Three Hours after Cardiac Surgery

Objective. Neutrophil gelatinase-associated lipocalin (NGAL) measured by a research ELISA is described as an early marker of acute kidney injury (AKI). The aim of this study is to define the usefulness of plasma NGAL (pNGAL) and urine NGAL (uNGAL) measured with platform analysers to detect AKI 3 hours after cardiac surgery in fifty adult patients. Methods and Main Results. pNGAL and uNGAL were measured before and 3 hours after cardiac surgery. AKI, defined following the acute kidney injury network definition, was observed in 17 patients. pNGAL was >149 ng/mL in 8 patients with AKI, two of them died in the follow-up. We also observed elevated pNGAL in 8 patients without AKI. Only one uNGAL was >132 ng/mL among the 15 AKI patients. Sensitivity of pNGAL for prediction of AKI is 47% and specificity is 75.7%. The positive likelihood ratio (LR+) is 1.9 and negative likelihood ratio (LR−) is 0.7. uNGAL performance is slightly improved when reported to urinary creatinine. Following this study, a ratio >62 ng/mg assure a sensitivity of 66.6% and a specificity of 78.5%. LR+ is 3 and a LR− is, 0.42. Conclusions. Three hours after cardiac surgery, pNGAL predicts AKI with a low sensitivity and specificity.

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DIAGNOSTIC VALUE OF BIOMARKERS OF ACUTE KIDNEY INJURY DEVELOPMENT AFTER CARDIAC SURGERY PERFORMED IN THE CONDITIONS OF CARDIOPULMONARY BYPASS

Vestnik of Vitebsk State Medical University ◽

10.22263/2312-4156.2021.2.45 ◽

2021 ◽

Vol 20 (2) ◽

pp. 45-55

Author(s):

D.I. Krachak ◽

◽

I.P. Klimchuk ◽

S.V. Mshar ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Kidney Injury ◽

Diagnostic Value ◽

Early Postoperative Period ◽

Diagnostic Efficiency

Objectives. To assess the diagnostic value of urinary lipocalin associated with neutrophil gelatinase (uNGAL) as a monomarker, as well as in combination with other indicators, in acute kidney injury (AKI) diagnosing in the early postoperative period in cardiac surgery patients. Material and methods. The analysis of 73 case histories of ICU patients after cardiac surgery in the conditions of cardiopulmonary bypass was performed. AKIN criteria were applied to diagnose AKI. The primary end point of the study was the postoperative level of uNGAL, the secondary end point was the indexed value of uNGAL. Results. 31 (42.4%) patients developed AKI (according to AKIN score). uNGAL had a very good level of diagnostic significance in detecting AKI (AUC 0.849, p=0.001) and its optimal cutoff level was more than 48.2 ng/ml within the time frame up to 12 hours after surgery. The diagnostic efficiency of the uNGAL test was: specificity - 88.1%, sensitivity - 67.74%, positive predictive value - 80.8%, negative predictive value - 78.7%, positive likelihood ratio - 5.57, negative likelihood ratio - 0.37. The ratio of uNGAL to leukocytes in the terms up to 12 hours after surgery demonstrated an excellent level of diagnostic value (AUC 0.920, p=0.001). The diagnostic efficiency of this indicator (more than 5.5 μg/1*10<sup>9</sup>) was: specificity - 94.74%, sensitivity - 73.68%, positive predictive value - 93.3%, negative predictive value - 78.3%, positive likelihood ratio - 14.0, negative likelihood ratio - 0.28. Conclusions. The diagnostic capabilities of uNGAL in detecting AKI in the early stages after cardiac surgery exceed the capabilities of serum creatinine traditionally used for this purpose. To improve the efficiency of AKI diagnosis in the early postoperative period, it is possible to use indexed indicators, for example, the ratio of uNGAL to leukocytes level in the patient’s blood.

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Increase of Neutrophil gelatinase-associated Lipocalin and Cystatin C after cardiac surgery – new options for detecting acute kidney injury

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297556 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

H Baumgarten ◽

C Liebetrau ◽

A Van Linden ◽

B Njezic ◽

T Walther ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cystatin C ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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Neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in children after cardiac surgery

The Bulletin of Bakoulev Center Cardiovascular Diseases ◽

10.24022/1810-0694-2019-20-1-26-32 ◽

2019 ◽

Vol 20 (1) ◽

pp. 26-32

Author(s):

A.A. Ivkin ◽

R.A. Kornelyuk ◽

D.L. Shukevich

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Kidney Injury ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery

Paediatrica Indonesiana ◽

10.14238/pi56.4.2016.230-7 ◽

2016 ◽

Vol 56 (4) ◽

pp. 230

Author(s):

Meta Herdiana Hanindita ◽

Riskky Vitria Prasetyo ◽

Ninik Asmaningsih Soemyarso ◽

I Ketut Alit Utamayasa ◽

Paul Tahalele

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Creatinine Clearance ◽

Sensitivity And Specificity ◽

Area Under The Curve ◽

Kidney Injury ◽

Schwartz Formula ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Plasma Ngal ◽

Neutrophil Gelatinase

Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.

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