Original scientific paper

https://doi.org/10.11613/BM.2018.030701

Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury after cardiac surgery

Giovanni Introcaso orcid.org/0000-0001-5765-8696 ; Unit of Laboratory Medicine, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Matteo Nafi ; Intensive Care Unit, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Alice Bonomi ; Units of Biostatistics, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Camilla L’Acqua ; Intensive Care Unit, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Luca Salvi ; Intensive Care Unit, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Roberto Ceriani ; Intensive Care Unit, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Davide Carcione ; Unit of Laboratory Medicine, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Annalisa Cattaneo ; Unit of Laboratory Medicine, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy
Maria Teresa Sandri ; Unit of Laboratory Medicine, Centro Cardiologico ‘’Monzino’’, IRCCS, Milan, Italy

Abstract

Introduction: Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population.
Materials and methods: Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the
intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea). Patients with at least two factors of AKI risk were selected and samples collected before the intervention and soon after the patient’s arrival in ICU. As reference standard, sCrea measurements
and urine outputs were evaluated to define the clinical AKI. A Triage Meter for plasma NGAL fluorescence immunoassay was used.
Results: Acute kidney injury occurred in 24 of the 69 patients (35%). Analysis of post-operative NGAL values demonstrated an AUC of 0.71, 95% CI
(0.60 - 0.82) with a cut-off = 154 ng/mL (sensitivity = 76%, specificity = 59%). Moreover, NGAL after surgery had a good correlation with the AKI
stage severity (P ≤ 0.001). Better diagnostic results were obtained with two consecutive tests: sensitivity 86% with a negative predictive value
(NPV) of 87%. At 10-18 h after surgery sCrea measurement, as confirmatory test, allowed to reach a more sensitivity and specificity with a NPV of 96%.
Conclusions: The assay results showed an improvement of NGAL diagnostic accuracy evaluating two tests. Consequently, NGAL may be useful for a timely treatment or for the AKI rule out in ICU patients.

Keywords

neutrophil gelatinase-associated lipocalin; acute kidney injury; cardiovascular surgery; diagnostic accuracy; AKI biomarkers

Hrčak ID:

206653

URI

https://hrcak.srce.hr/206653

Publication date:

15.10.2018.

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