Department of Cardiology, University & Hospital Fribourg, Switzerland;
Swiss Med Wkly. 2013 Aug 27;143:w13853. doi: 10.4414/smw.2013.13853. eCollection 2013.
Diagnosis of acute kidney injury (AKI) relies on measurement of serum creatinine (SCr). SCr is a late marker of impaired renal function. Urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) has given encouraging results for an early and sensitive detection of AKI. This cohort study was conducted (1) to assess the value of uNGAL as early marker of contrast-induced AKI (CI-AKI) in unselected patients undergoing percutaneous coronary procedure (PCP) and (2) to investigate whether uNGAL levels correlate with the volume of contrast medium (CM) used during the procedure.
We enrolled 244 consecutive adult patients undergoing PCP done with the low-osmolar CM Iomeprolum (median volume of CM 122 [88-168] ml per procedure). uNGAL was measured at its peak with a standardised clinical laboratory platform (ARCHITECT uNGAL assay, Abbott).
Overall, the post-PCP uNGAL levels were extremely low in our cohort with a median value of 7.7 [4.0-14.5] ng/ml (N ≤132 ng/ml). Twenty-five (10%) patients developed CI-AKI according to the classical diagnostic criteria (≥25% or ≥44.2 µmol/l increase in SCr) and 8 (3.3%) patients according to the AKIN criteria. Regardless of the definition considered, uNGAL levels did not significantly differ in patients with or without CI-AKI. Similarly, we found no significant correlation between the volume of CM used and the post-PCP uNGAL levels (r = -0.11).
In a large cohort of unselected adult patients, uNGAL measured four to six hours after PCP was ineffective to predict the risk of CI-AKI and did not correlate with the volume of CM used during the procedure.
急性肾损伤（AKI）的诊断依赖于血清肌酐（SCr）的测量。SCr 是肾功能受损的晚期标志物。尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）在早期和敏感检测 AKI 方面取得了令人鼓舞的结果。本队列研究旨在：（1）评估 uNGAL 作为接受经皮冠状动脉介入治疗（PCP）的未选择患者对比剂诱导 AKI（CI-AKI）的早期标志物的价值；（2）研究 uNGAL 水平是否与该过程中使用的对比剂（CM）量相关。
我们纳入了 244 例连续成年患者，他们接受了低渗性 CM Iomeprolum（每个程序的 CM 体积中位数为 122 [88-168] ml）的 PCP。使用标准化临床实验室平台（ARCHITECT uNGAL 测定法，雅培）测量峰值 uNGAL。
总体而言，我们队列的 PCP 后 uNGAL 水平极低，中位数为 7.7 [4.0-14.5] ng/ml（N ≤132 ng/ml）。根据经典诊断标准（SCr 升高≥25%或≥44.2 µmol/l），25 例（10%）患者发生 CI-AKI，根据 AKIN 标准，8 例（3.3%）患者发生 CI-AKI。无论采用何种定义，CI-AKI 患者和无 CI-AKI 患者的 uNGAL 水平均无显著差异。同样，我们也发现 CM 体积与 PCP 后 uNGAL 水平之间无显著相关性（r = -0.11）。
在大量未选择的成年患者队列中，PCP 后 4 至 6 小时测量的 uNGAL 不能预测 CI-AKI 的风险，也与该过程中使用的 CM 体积无关。
