Association of plasma and urine NGAL with acute kidney injury after elective colorectal surgery: A cohort study

Abstract

Background Acute kidney injury (AKI) is common in surgical patients. We aimed to investigate the validity of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in the detection of AKI and prediction of outcomes in patients undergoing major colorectal surgery. Materials and methods This was a pre-specified post-hoc analysis of a randomized controlled trial comparing oesophageal doppler and Lithium dilution cardiac output monitoring in high risk patients undergoing major colorectal surgery as part of an Enhanced Recovery After Surgery protocol in a tertiary care hospital. Plasma and urine samples for NGAL measurement were taken before surgery (T1), immediately after surgery (T2), and on postoperative day 1 (T3). AKI was defined according to the KDIGO criteria. Results A total of 89 patients were included of whom 12 (13.5%) developed AKI. Plasma NGAL significantly increased from T1 to T3 in both AKI (p < 0.001) and non-AKI (p = 0.048) patients, while urine NGAL did not change over time. There were no significant differences in plasma and urine NGAL in patients with and without AKI at all time points. Postoperative day 1 urine NGAL concentrations were significantly higher in non-survivors than survivors (41.2 versus 25 ng/mL, p = 0.026). One-year mortality was significantly higher in AKI patients with a raised urine NGAL compared to AKI patients without elevated urine NGAL levels. Conclusions Plasma and urine NGAL poorly predicted AKI post-colorectal surgery. Non-survivors had higher urine NGAL results. More research is required to explore the association between NGAL and long-term outcomes.

Prevalence and risk factors of Acute kidney injury after colorectal cancer surgery

“…In the current study, 10.3% of the patients developed AKI postoperatively (80% of them stage 1, 18% stage 2, and 2% stage 3). These ndings are consistent with Lumlertgul et al who studied 89 patients undergoing CRC surgery and observed AKI in 13.5% of them (75% AKI stage 1, 17% stage 2, and 1 patient stage 3) [10]. Also, a meta-analysis by O'Connor et al on 19 articles describing AKI outcomes in 82,514 patients post major abdominal surgery including CRC surgery, found that pooled incidence of AKI was 13.4% [11].…”

Metabolic change in monocytes and postoperative morbidity after major abdominal surgery in elderly patients: A prospective cohort study

“…Researches have indicated several biomarkers for predicting perioperative complications, including B-type natriuretic peptide (BNP) [ 7 ], neutrophil gelatinase-associated lipocalin (NGAL) [ 8 ] and S100B protein [ 9 ]. These predictive biomarkers reflect heterogeneity in individual responses to surgery and could not be dynamically assessed perioperatively.…”

“…However, as damage markers of organs, one biomarker only show predictive value in one specific organ or system. For example, as a marker of tubular damage, NGAL has been demonstrated closely associated with acute kidney injury (AKI) after cardiac and colorectal surgery [ 8 , 10 ]. Therefore, there is a pressing need for new biomarkers to predict the overall risk of aging people during perioperative period.…”