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

Abstract

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.

Novel renal biomarker evaluation for early detection of acute kidney injury after transcatheter aortic valve implantation

“…NGAL is involved in the innate immune system and has been reported to predict AKI after cardiopulmonary bypass (CPB) in a pediatric population 19,20 as well as in adults [21][22][23][24][25][26] and after coronary angiography and percutaneous coronary intervention. 27,28 Similarly, KIM-1, a type-1 transmembrane protein, has been shown to be predictive of AKI following CPB, 29,30 coronary artery bypass grafting, 31 and valve surgery.…”

Biomarker-Guided Risk Assessment for Acute Kidney Injury: Time for Clinical Implementation?

“…2 ). Owing to its nature and intrinsic properties, NGAL is essentially considered as a marker of structural tubular injury, but not of glomerular filtration such as SCr or excretory function (urine-output) [ 94 ]. Multiple studies investigating either perioperative changes in proteinuria [ 73 , 95 ], NGAL [ 73 , 95 , 96 ], or cell cycle arrest markers [ 78 ] have demonstrated that patients with SCr-based AKI and the highest biomarker concentrations were at the highest risk of adverse kidney events such as RRT and mortality.…”

Predicting acute kidney injury: current status and future challenges

“…Even if the primary results are really encouraging, the use of Cys-C, NGAL or other alternative makers of early AKI is still an area of ongoing research [ 107 ]. Indeed, recently some authors have shown that there are a couple of “blind spots” in the use of these new markers and, sometimes, the real meaning of the increased levels of NGAL, KIM-1 or other biomarkers is not completely understood [ 108 , 109 ]. Some authors reported the inability of these new biomarkers to predict AKI with sufficient clinical pertinence to justify the cost of these analyses in routine practice [ 109 , 110 ].…”

“…Indeed, recently some authors have shown that there are a couple of “blind spots” in the use of these new markers and, sometimes, the real meaning of the increased levels of NGAL, KIM-1 or other biomarkers is not completely understood [ 108 , 109 ]. Some authors reported the inability of these new biomarkers to predict AKI with sufficient clinical pertinence to justify the cost of these analyses in routine practice [ 109 , 110 ]. And some of the biomarkers have still not been evaluated with enough data in very specific populations (infant and elderly) [ 43 , 111 ].…”