Creatinine, Neutrophil Gelatinase‐Associated Lipocalin, and Cystatin C in Determining Acute Kidney Injury After Heart Operations Using Cardiopulmonary Bypass

Abstract

Acute kidney injury (AKI) represents frequent complication after cardiac surgery using cardiopulmonary bypass (CPB). In the hope to enhance earlier more reliable characterization of AKI, we tested the utility of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in addition to standard creatinine for early determination of AKI after cardiac surgery using CPB. Forty-one patients met the inclusion criteria. Arterial blood samples collected after induction of general anesthesia were used as baseline, further sampling occurred at CPB termination, 2 h after CPB, on the first and second day after surgery. According to AKIN classification 18 patients (44%) developed AKI (AKI1-2 groups) and 23 (56%) did not (non-AKI group). Groups were similar regarding demographics and operative characteristics. CysC levels differed already preoperatively (non-AKI vs. AKI2; P = 0.045; AKI1 vs. AKI2; P = 0.011), while postoperatively AKI2 group differed on the first day and AKI1 on the second regarding non-AKI group (P = 0.004; P = 0.021, respectively). NGAL and creatinine showed significant difference already 2 h after CPB between groups AKI2 and non-AKI and later on the first postoperative day between groups AKI1 and AKI2 (P = 0.028; P = 0.014, respectively). This study shows similar performance of early plasma creatinine and NGAL in patients with preserved preoperative renal function. It demonstrates that creatinine, as well as NGAL, differentiate subsets of patients developing AKI of clinically more advanced grade early after 2 h, also when used single and uncombined.

Cardiac surgery–associated neutrophil gelatinase–associated lipocalin score for postoperative acute kidney injury: What is the clinical implication?

“…4 In our view, combining NGAL with conventional creatinine, cystatin C, or even both is a ''must do,'' especially for patients with preexisting impaired kidney function, in whom the values of creatinine and NGAL are less representative. 5 Such paired biomarker composites might enhance an earlier identification of acute tubular damage, providing the opportunity to institute highly targeted renal-protective strategies. http://dx.doi.org/10.1016/j.jtcvs.2017.03.088…”

Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD

“… 20 Unlike SCr, cystatin C is a representative marker of kidney function and is not influenced by muscle mass, age, sex, or protein intake. 21 Cystatin C is a cysteine proteinase inhibitor, which has a half-life of approximately 50% that of creatinine; hence, serum cystatin C levels change earlier than those of creatinine. 22 , 23 On even mild kidney injury, serum cystatin C begins to increase at 24–48 h before SCr and gradually increases during disease progression.…”

Diagnostic performance of plasma and urine neutrophil gelatinase-associated lipocalin, cystatin C, and creatinine for acute kidney injury in burn patients: A prospective cohort study

“…Cystatin C is a representative marker of kidney function and not influenced by muscle, age, gender and protein intake unlike creatinine [ 6 ]. It is a 133-kDa cysteine proteinase inhibitor protein, which has half the life of creatinine (90–120 min compared to 4 h), so the serum level of Cystatin C changes earlier than that of creatinine.…”