Plasma neutrophil gelatinase-associated lipocalin as an early predicting biomarker of acute kidney injury and clinical outcomes after recovery of spontaneous circulation in out-of-hospital cardiac arrest patients

Park, Sang O; Ahn, Ji Yun; Lee, Young Hwan; Kim, Yu Jung; Min, Yong Hun; Ahn, Hyun Joo; Sohn, Young-Jun; Park, Seung Min; Oh, Young Taeck; Shin, Dong Hyuk

doi:10.1016/j.resuscitation.2016.01.005

Cited by 19 publications

(23 citation statements)

References 25 publications

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“…Contrastinduced AKI could be predicted by NGAL measurement at 2 hours after contrast administration [21,[31][32][33]. In studies that analysed the association of NGAL in patients with post-OHCA AKI, the timepoint of NGAL varied from immediately after ROSC to several days later, and there were differences in AUROCs or ORs of NGAL for AKI depending on the time of measurement [13][14][15][16]. However, no studies have comparatively evaluated NGAL values that were measured immediately after ROSC with those measured hours later.…”

Section: Discussionmentioning

confidence: 99%

“…Several reports of the positive association between AKI and NGAL in post-cardiac arrest patients indicate that NGAL could be used as a predictive marker of AKI; however, in those studies, the timepoint of NGAL measurement varied from immediately after ROSC to several days later [13][14][15][16]. If the NGAL level in early-stage of ROSC is correlated with the occurrence of AKI, then, this would enable the prediction of AKI and the early initiation of appropriate management.…”

Section: Introductionmentioning

confidence: 99%

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Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

Choi

Lee

2020

Preprint

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Background: Serum neutrophil gelatinase-associated lipocalin (NGAL) could be used as a predictive marker of acute kidney injury (AKI) in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) who are managed with targeted temperature management (TTM). However, the NGAL measurement timepoints vary from immediately after ROSC to several days later. The primary objective of this study was to determine an association between AKI and NGAL, both immediately (ROSC-NGAL) and 3 hours after ROSC (3h-NGAL), in OHCA patients with TTM. The secondary objective was to ascertain the association between NGAL levels in the early post-ROSC phase and the neurologic outcomes at discharge.Methods: This prospective observational study was conducted between January 2016 and December 2018 and enrolled adult OHCA patients (≥18 years) with TTM after ROSC. The serum NGAL level was measured both immediately and 3 hours after ROSC. Univariate and multivariate analyses were performed to identify the associations between AKI, poor neurologic outcome, and NGAL.Results: Among 861 OHCA patients, 89 patients were enrolled. AKI occurred in 48 (55.1%) patients. On multivariate logistic regression analysis, 3h-NGAL was significantly associated with AKI (odds ratio [OR] 1.022; 95% confidence interval [CI] 1.009–1.035; p = 0.001). The area under the receiver operating characteristic curve of 3h-NGAL for AKI was 0.910 (95% CI 0.830–0.960), and a cut-off value of 178 ng/mL was identified. Both ROSC-NGAL and 3h-NGAL were not significantly associated with poor neurologic outcome on multivariate logistic regression analysis (ROSC-NGAL; OR 1.017; 95% CI 0.998–1.036; p = 0.084, 3h-NGAL; OR 0.997; 95% CI 0.992–1.001; p = 0.113)Conclusions: The serum NGAL concentration measured 3 hours after ROSC is an excellent early predictive marker for AKI in OHCA patients treated with TTM. Future research is needed to identify the optimal measurement timepoint to establish NGAL as a predictor of neurologic outcome and to validate the findings of this research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

Choi

Lee

2020

Preprint

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“…Elmer et al reported that serum NGAL was a stronger predictor of hospital mortality in cardiac arrest patients than other markers, such as NSE, S100B protein, and high-mobility group protein 1 [9]. Park et al reported that serum NGAL predicted AKI in OHCA patients admitted to an intensive care unit, as well as the 30-day survival and neurological outcomes in these patients [8]. In the present study, serum NGAL on day 2 showed potential predictive value for the neurological outcomes at discharge of OHCA patients.…”

Section: Discussionmentioning

confidence: 99%

“…PCAS is sometimes referred to as sepsis-like syndrome. Several studies have revealed that blood NGAL concentrations are increased in PCAS patients, and that NGAL might predict the clinical outcomes of these patients, as already reported in sepsis patients [8, 9]. However, these studies were not sufficient to conclude that NGAL is a predictor of neurological outcomes.…”

Section: Introductionmentioning

confidence: 93%

Serum neutrophil gelatinase-associated lipocalin levels predict the neurological outcomes of out-of-hospital cardiac arrest victims

Kaneko

Fujita

Ogino

et al. 2017

BMC Cardiovasc Disord

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BackgroundSerum neutrophil gelatinase-associated lipocalin (NGAL) is a well-known biomarker of acute kidney injury. Serum NGAL was recently proposed as a potential predictor of mortality in post cardiac arrest syndrome (PCAS) patients following out-of-hospital cardiac arrest (OHCA). However, the potential predictive value of NGAL for neurological outcomes is unknown. Therefore, we assessed the potential predictive value of NGAL for neurological outcomes after OHCA. We also compared its predictive value with that of neuron-specific enolase (NSE) as an established biomarker.MethodsBlood samples were prospectively collected from 43 PCAS patients following OHCA. Serum NGAL was measured on days 1 and 2, and NSE was measured on day 2. These biomarkers were compared between patients with favourable (cerebral performance category [CPC] 1–2) and unfavourable (CPC 3–5) outcomes. Receiver operating characteristic (ROC) curve analysis was performed.ResultsSerum NGAL and NSE on day 2 (both P < 0.001), but not NGAL on day 1 (P = 0.609), were significantly different between the favourable and unfavourable groups. In ROC curve analysis, the sensitivity and specificity were 83% and 85%, respectively, for NGAL (day 2) at a cutoff value of 204 ng/mL and were 84% and 100% for NSE (day 2) at a cutoff value of 28.8 ng/mL. The area under the ROC curve of NGAL (day 2) was equivalent to that of NSE (day 2) (0.830 vs. 0.918). Additionally, the area under the ROC curve in subgroup of estimated glomerular filtration rate (eGFR) > 20 mL/min/1.73 m2 (n = 38, 0.978 vs. 0.923) showed the potential of NGAL predictability.ConclusionsSerum NGAL might predict the neurological outcomes of PCAS patients, and its predictive value was equivalent to that of NSE.

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“…Relative to the above confusing results, using biomarkers to assess hypothermia treatment appears to be more clarity and reliable. Both NGAL and CysC are sensitive for the prediction of moderate-to-severe kidney injury in the early stage after ROSC [20][21][22] .NGAL is expressed in epithelial cells in different organs, and is considered to be an inflammatory mediator whose expression is upregulated in tubular injury. In CA patients, NGAL measured in blood within 4h after ROSC is a predictor of AKI…”

Section: ■ Discussionmentioning

confidence: 99%

Effect of mild hypothermia on renal ischemia/reperfusion injury after cardiopulmonary resuscitation in a swine model

Yuan

Zhao

et al. 2017

Acta Cir. Bras.

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Purpose: To investigate the effect of intravascular cooling on renal function after resuscitation. Methods: Twenty four pigs were randomized into three groups (n=8 in each group): therapeutic hypothermia group (TH group), normothermia group (NH group) and sham operation group (SHAM group). After 6 minutes of untreated VF, CPR was performed. Upon ROSC, the TH group received the intravascular cooling. The NH and SHAM group did not undergo therapeutic hypothermia. Haemodynamic parameters were recorded. The bloods were analyzed for serum creatinine (sCr), CysC and NGAL. The kidney was surgically removed observe pathologic changes under a light microscope. Results: The sCr increased in both TH and NH groups after ROSC, compared to baseline. Between two groups, the sCr and creatinine clearance (Cc) showed lower level in the TH group. The urine volume per hour in the TH group were higher during cooling. After resuscitation, NGAL and CysC in the NH group were higher than in the TH group. Under the light microscope, compared with the TH group, the renal injury was prominent in the NH group. Conclusion: Mild hypothermia had a protection to renal ischemia reperfusion injury after resuscitation.

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Plasma neutrophil gelatinase-associated lipocalin as an early predicting biomarker of acute kidney injury and clinical outcomes after recovery of spontaneous circulation in out-of-hospital cardiac arrest patients

Cited by 19 publications

References 25 publications

Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

Serum Neutrophil Gelatinase-associated Lipocalin at 3 Hours after Return of Spontaneous Circulation in Patients with Cardiac Arrest and Therapeutic Hypothermia: Early Predictor of Acute Kidney Injury

Serum neutrophil gelatinase-associated lipocalin levels predict the neurological outcomes of out-of-hospital cardiac arrest victims

Effect of mild hypothermia on renal ischemia/reperfusion injury after cardiopulmonary resuscitation in a swine model

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