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Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance.
Clin J Am Soc Nephrol. 2010 Feb; 5(2):211-9.CJ

Abstract

BACKGROUND AND OBJECTIVES

Neutrophil gelatinase-associated lipocalin (NGAL) is rapidly released by renal tubules after injury, potentially allowing early identification of acute kidney injury (AKI) after cardiac surgery. However, the diagnostic performance of NGAL has varied widely in clinical studies, and it remains unknown what factors modify the relationship between NGAL and AKI. We hypothesized the relationship between urinary NGAL and AKI would vary with baseline renal function, allowing a stratified analysis to improve diagnostic performance of this novel biomarker.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We performed a prospective observational study in 426 adult cardiac surgical patients. Urinary NGAL was serially determined, commencing preoperatively and continuing 24 hours postoperatively. AKI was defined as increase in serum creatinine from baseline by either >50% or >0.3 mg/dl within 48 hours postoperatively. Patients were stratified by baseline estimated GFR (eGFR). NGAL levels were compared between patients with and without AKI and diagnostic characteristics determined according to baseline eGFR.

RESULTS

In patients with baseline eGFR >or=60 ml/min, urinary NGAL was higher at all postoperative time points in patients who developed AKI compared with those who did not. In patients with baseline eGFR <60 ml/min, urinary NGAL did not differ at any time between those who did and those who did not develop AKI. Postoperative NGAL best identified AKI in patients with baseline eGFR 90 to 120 ml/min.

CONCLUSIONS

The relationship between urinary NGAL and AKI after cardiac surgery varies with baseline renal function, with optimal discriminatory performance in patients with normal preoperative function.

Authors+Show Affiliations

Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, PH-5, Suite 523, New York, New York 10032, USA. dm2655@columbia.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20056755

Citation

McIlroy, David R., et al. "Neutrophil Gelatinase-associated Lipocalin and Acute Kidney Injury After Cardiac Surgery: the Effect of Baseline Renal Function On Diagnostic Performance." Clinical Journal of the American Society of Nephrology : CJASN, vol. 5, no. 2, 2010, pp. 211-9.
McIlroy DR, Wagener G, Lee HT. Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. Clin J Am Soc Nephrol. 2010;5(2):211-9.
McIlroy, D. R., Wagener, G., & Lee, H. T. (2010). Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. Clinical Journal of the American Society of Nephrology : CJASN, 5(2), 211-9. https://doi.org/10.2215/CJN.04240609
McIlroy DR, Wagener G, Lee HT. Neutrophil Gelatinase-associated Lipocalin and Acute Kidney Injury After Cardiac Surgery: the Effect of Baseline Renal Function On Diagnostic Performance. Clin J Am Soc Nephrol. 2010;5(2):211-9. PubMed PMID: 20056755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. AU - McIlroy,David R, AU - Wagener,Gebhard, AU - Lee,H Thomas, Y1 - 2010/01/07/ PY - 2010/1/9/entrez PY - 2010/1/9/pubmed PY - 2010/5/8/medline SP - 211 EP - 9 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 5 IS - 2 N2 - BACKGROUND AND OBJECTIVES: Neutrophil gelatinase-associated lipocalin (NGAL) is rapidly released by renal tubules after injury, potentially allowing early identification of acute kidney injury (AKI) after cardiac surgery. However, the diagnostic performance of NGAL has varied widely in clinical studies, and it remains unknown what factors modify the relationship between NGAL and AKI. We hypothesized the relationship between urinary NGAL and AKI would vary with baseline renal function, allowing a stratified analysis to improve diagnostic performance of this novel biomarker. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We performed a prospective observational study in 426 adult cardiac surgical patients. Urinary NGAL was serially determined, commencing preoperatively and continuing 24 hours postoperatively. AKI was defined as increase in serum creatinine from baseline by either >50% or >0.3 mg/dl within 48 hours postoperatively. Patients were stratified by baseline estimated GFR (eGFR). NGAL levels were compared between patients with and without AKI and diagnostic characteristics determined according to baseline eGFR. RESULTS: In patients with baseline eGFR >or=60 ml/min, urinary NGAL was higher at all postoperative time points in patients who developed AKI compared with those who did not. In patients with baseline eGFR <60 ml/min, urinary NGAL did not differ at any time between those who did and those who did not develop AKI. Postoperative NGAL best identified AKI in patients with baseline eGFR 90 to 120 ml/min. CONCLUSIONS: The relationship between urinary NGAL and AKI after cardiac surgery varies with baseline renal function, with optimal discriminatory performance in patients with normal preoperative function. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/20056755/Neutrophil_gelatinase_associated_lipocalin_and_acute_kidney_injury_after_cardiac_surgery:_the_effect_of_baseline_renal_function_on_diagnostic_performance_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=20056755 DB - PRIME DP - Unbound Medicine ER -