The combined use of neutrophil gelatinase-associated lipocalin and brain natriuretic peptide improves risk stratification in pediatric cardiac surgery

Abstract

Background : The aim of this study is to test the hypothesis whether the combined use of a cardio-specifi c biomarker, the brain natriuretic peptide (BNP) and a marker of early renal damage, the assay of urinary neutrophil gelatinase-associated lipocalin (uNGAL), may improve risk stratifi cation in pediatric cardiac surgery. Methods: We prospectively enrolled 135 children [median age 7 (interquartile range 1 -49) months] undergoing to cardiac surgery for congenital heart disease. All biomarkers were evaluated pre-and post-operatively at different times after cardiopulmonary-bypass (CPB): uNGAL at 2, 6 and 12 h; BNP at 12 and 36 h; serum creatinine at 2, 6, 12, and 36 h. Primary endpoints were development of acute kidney injury (AKI) (defi ned as 1.5 serum creatinine increase) and intubation time. Results: AKI occurred in 39 % of patients (65 % neonates and 32 % older children, p = 0.004). The peak of uNGAL values occurred more frequently at 2 h. uNGAL values at 2 h [median 28.2 (interquartile range 7.0 -124.6) ng/L] had a good diagnostic accuracy for early diagnosis of AKI with an AUC (area under the curve) ROC (receiver operating characteristic) curve of 0.85 (SE 0.034). Using multivariable logistic regression analysis, development of AKI was signifi cantly associated with uNGAL values at 2 h after CPB [OR = 1.88 (1.30 -2.72, p = 0.001)], together with the CPB time and Aristotle score, as an index of complexity of the surgical procedure, while pre-operative BNP values were not. Furthermore, uNGAL and pre-operative BNP values (together with Aristotle score) were signifi cantly associated with adverse outcome (longer intubation time and mortality).

Early prediction of acute kidney injury in neonates with cardiac surgery

“…In four studies including neonates, the rise in urinary NGAL (uNGAL) occurs as early as about 2 hours after surgery and shows good diagnostic ability for CS-AKI regardless of AKI definitions, even normalized by creatinine, and can be one of the independent risk factors for adverse clinical outcomes. [16][17][18][19][20][21][22] Other studies also indicate that the value of uNGAL within 12 hours after surgery is a strong predictor of CS-AKI, and it is significantly associated with poor outcomes. 21 23 24 A study including 30 neonatal patients concludes that, besides postoperative serum NGAL (sNGAL), preoperative sNGAL is also a potential indicator of CS-AKI.…”

B-Type Cardiac Natriuretic Peptides in the Neonatal and Pediatric Intensive Care Units

“…There are sufficient evidences on the prognostic role of BNP-NT-proBNP in children undergoing cardiac surgery. [71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89][90] As reported by multiple authors. BNP levels (especially those measured preoperatively) were independently associated with important parameters of outcome, including the duration of mechanical ventilation, intensive care unit stay, need for inotropic support, and low cardiac output syndrome.…”

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

“…The Pediatric Risk Mortality Score (PRISM III [17]) was calculated at admission. Respiratory support was considered as the total intubation time after surgery, measured by the number of hours on mechanical ventilation (MV) [18]. Hemodynamic support after cardiac surgery was analyzed using the vasoactive-inotropic score (VIS score [19]).…”

“…BNP and proBNP have been the most commonly studied biomarkers for heart failure and major complications after heart surgery in children [9,18,20,22,36,[41][42][43][44]. However, their usefulness before cardiac surgery has not been standardized [13].…”