Plasma neutrophil gelatinase-associated lipocalin as an early biomarker for prediction of acute kidney injury after cardio-pulmonary bypass in pediatric cardiac surgery

Abstract

IntroductionCardiopulmonary bypass (CPB) surgery is considered one of the most frequent surgical procedures in which acute kidney injury (AKI) represents a frequent and serious complication. The aim of the present study was to evaluate the efficiency of neutrophil gelatinase-associated lipocalin (NGAL) as an early AKI biomarker after CPB in pediatric cardiac surgery.Material and methodsThe study included forty children aged 2 to 78 months undergoing CPB. They were divided into group I: patients who suffered AKI grades II and III; and group II: patients who did not develop AKI or at risk. Peripheral venous blood was withdrawn pre- and post-operatively for serial measurements of NGAL and creatinine. Statistical analysis was performed using Statistical Package for Social Sciences version 14.ResultsMean plasma NGAL levels showed highly significant elevations in group I patients at 2, 12, and 24 h after surgery (p < 0.0001) compared to group II. Significant correlations were found between NGAL and creatinine at different time intervals. Highly significant correlations (p < 0.0001) were found between plasma NGAL and AKI at 2, 12 and 24 h after surgery. A cut-off level of 100 ng/ml at 2 h, and 125 ng/ml at 12 h post-operatively both recorded the highest accuracy, being 95% accurate, with sensitivity of 100% and 89.5% respectively, and specificity of 90.5% and 100% respectively.ConclusionsThis study showed that plasma NGAL could be used as an early biomarker for detection of AKI following CPB. We recommend further studies on a wider scale to validate the current study results.

The Effect of Methylprednisolone on Plasma Concentrations of Neutrophil Gelatinase–Associated Lipocalin in Pediatric Heart Surgery*

“…It is important to note that the present results do not challenge the fact that increased plasma NGAL concentration after pediatric heart surgery predicts evolving AKI (3,(16)(17)(18), although some negative findings do exist (19,20). Instead, the interpretation of the present findings offers an alternative pathophysiologic mechanism for this phenomenon.…”

The potential use of biomarkers in predicting contrast-induced acute kidney injury

“…Haase-Fielitz et al, [88][89][90] Fadel et al, 91 and Krawczeski et al 92 have found similar results in a prospective study of adult cardiac surgery patients. In studies performed in critically ill patients with septic shock, Nickolas et al 93 found urinary NGAL to predict AKI with an AUC of 0.95.…”

Emerging Biomarkers and Metabolomics for Assessing Toxic Nephropathy and Acute Kidney Injury (AKI) in Neonatology

“…Both urine and plasma NGAL were powerful independent predictors of AKI, with an AUC of 0.998 for the 2-hour urine NGAL and 0.91 for the 2-hour plasma NGAL measurement. A conspicuous number of studies on NGAL for assessing AKI in the course of cardiac surgery have subsequently confirmed the results published by Mishra [114–120]. In a prospective study, uNGAL was measured immediately after kidney transplantation and then for subsequent 3 times every 6 hours [121].…”