Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome

Abstract

Background: Contrast-induced nephropathy (CIN) following a percutaneous coronary intervention (PCI) is the third most common cause of acute kidney injury (AKI) worldwide. Patients who require hemodialysis secondary to CIN have an elevated mortality rate as high as 55%. The current definition of CIN is based on an elevation of creatinine and decrease in urinary output. Creatinine typically increases 48 h after the contrast exposure, which delays the diagnosis and treatment of CIN. The neutrophil gelatinase associated lipocalin (NGAL) has emerged as a sensitive and specific biomarker of renal injury. Limited data exists about the effectiveness of NGAL to predict CIN in highrisk patients with acute coronary syndrome (ACS) that underwent PCI. The primary aim of this study was to determine the association of serum NGAL levels and the need for hemodialysis after PCI. Methods: This is a prospective, observational study. NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 h of hospital admission, and 12 and 24 h after contrast exposure from angiography. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U test was used to test for differences in median serum levels of NGAL. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict the need for hemodialysis after PCI. Results: A total of 2875 were screened; however, 45 patients with ACS that underwent PCI were included. All patients were at high risk of developing CIN defined by Mehran score > 11 points. The median (IQR) serum concentration of NGAL was significantly higher in patients that required versus did not require hemodialysis (340 [83-384] vs. 169 [100-210], p = 0.01). Elevated serum levels of NGAL with a cutoff at 6 h post PCI of 281 mg/dL predicted the need for hemodialysis with an area under the curve of 0.86 (95% CI, 0.66-1.00).

Biomarkers in Contrast-Induced Acute Kidney Injury: Towards A New Perspective

“…One of the most ambitious studies based on large cohorts of patients, both children, and adults, receiving contrast agents and undergoing cardiac catheterization, intra-arterial coronary angiography, or computed tomography (CT), revealed a very good performance of plasma and uNGAL in the prediction of CI-AKI [ 84 , 85 ]. More recently, uNGAL monitoring studies revealed that NGAL also predicted the severity of CI-AKI into CKD and/or hemodialysis progression, demonstrating that NGAL is potentially superior compared to conventional markers of nephropathy after invasive coronary procedures with contrast agents [ 86 , 87 , 88 , 89 , 90 ].…”

Biomarkers in Contrast-Induced Acute Kidney Injury: Towards a new perspective.

“…More recently, uNGAL monitoring studies revealed that NGAL also predicted the severity of CI-AKI into CKD and/or hemodialysis progression, demonstrating that NGAL is potentially superior compared to conventional markers of nephropathy after invasive coronary procedures with contrast agents [59][60][61][62][63]. However, ANTI-CI-AKI clinical trial study concluded that uNGAL was not able to predict CI-AKI and was an inadequate tool to guide an early intervention strategy to prevent CI-AKI outcomes [64] and further studies will be necessary.…”

Effects of pneumoperitoneum on kidney injury biomarkers: A randomized clinical trial

“…In patients who do not progress with acute kidney injury, NGAL decreases after 1 hour of injury [ 2 ]. Thus, it has been shown to be a good predictor of indication for hemodialysis [ 3 ].…”