Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients
| Autor: | Neil J Glassford, Glenn M Eastwood, Antoni J. Betbese, M.ª Victoria Moral, Rinaldo Bellomo, Marta Argilaga, Jordi Ordoñez, Mercedes Garcia-Alvarez, Alfonso Martínez, Antoine G. Schneider, Satoshi Suzuki, Victoria Baños |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Urinary system law.invention Cohort Studies chemistry.chemical_compound Postoperative Complications Lipocalin-2 Predictive Value of Tests law Proto-Oncogene Proteins Internal medicine Cardiopulmonary bypass medicine Humans Prospective Studies Renal replacement therapy Cardiac Surgical Procedures Aged Aged 80 and over Creatinine Kidney business.industry Acute kidney injury Middle Aged medicine.disease Lipocalins Surgery Cardiac surgery Treatment Outcome Anesthesiology and Pain Medicine medicine.anatomical_structure chemistry Cardiology Female Cardiology and Cardiovascular Medicine business Biomarkers Acute-Phase Proteins Kidney disease |
| Zdroj: | Journal of Cardiothoracic and Vascular Anesthesia. 29:1480-1488 |
| ISSN: | 1053-0770 |
| DOI: | 10.1053/j.jvca.2015.05.060 |
| Popis: | To determine the ability of urinary neutrophil gelatinase-associated lipocalin (uNGAL) to predict cardiac surgery-associated acute kidney injury (CSA-AKI), continuous renal replacement therapy (CRRT), mortality, and a composite outcome of major adverse kidney events at 365 days (MAKE365), and to investigate the influence of cardiopulmonary bypass (CPB) on NGAL release.A prospective observational study.A single-center university hospital.A cohort of 288 adult cardiac surgery patients.uNGAL was measured at baseline, immediately after surgery, and on days 1 and 2 postoperatively. The authors used the recent Kidney Disease Improving Global Outcomes consensus criteria to define CSA-AKI.CSA-AKI occurred in 36.1% of patients. uNGAL rapidly became significantly higher in patients who developed AKI, with peak value immediately after surgery (349.9 [76.6-1446.6] v 90.1 [20.8-328] ng/mg creatinine; p0.001). No measure of uNGAL (peak, postsurgery, day 1 or 2 postsurgery) accurately predicted CSA-AKI, CRRT, mortality, or MAKE365. However, immediately after surgery, CPB induced greater uNGAL release compared with off-pump surgery (265.5 µmol/L [71-989.6] v 48.7 ng/mg creatinine [17-129.8]; p0.001). Moreover, such early uNGAL release correlated with CPB duration (r = 0.505; p0.001) but not with peak serum creatinine values on day 3 or 7 after surgery.uNGAL had a limited predictive ability for CSA-AKI or other relevant clinical outcomes after cardiac surgery and appeared to be more closely related to the use and duration of CPB. Thus, its levels may represent the aggregate effect of an inflammatory response to CPB as well as a renal response to cardiac surgery and inflammation. |
| Databáze: | OpenAIRE |
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