Quintavalle Cristina, Anselmi Chiara Viviani, De Micco Francesca, Roscigno Giuseppina, Visconti Gabriella, Golia Bruno, Focaccio Amelia, Ricciardelli Bruno, Perna Enzo, Papa Laura, Donnarumma Elvira, Condorelli Gerolama, Briguori Carlo
From the Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., E.D.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., E.D.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council, Naples, Italy (G.R., L.P., G.C.); and SDN Foundation, Naples, Italy (E.D.).
Circ Cardiovasc Interv. 2015 Sep;8(9):e002673. doi: 10.1161/CIRCINTERVENTIONS.115.002673.
Neutrophil gelatinase-associated lipocalin (NGAL) is an early marker of acute kidney injury (AKI).
Urine NGAL and serum NGAL (sNGAL) were assessed at 2, 6, 24, and 48 hours after contrast media (CM) exposure in 458 high-risk patients (development set). Optimal thresholds in predicting contrast-induced AKI (serum creatinine [sCr] increase ≥0.3 mg/dL at 48 hours after CM administration) were identified. Major adverse events (MAE; death, dialysis, nonfatal myocardial infarction, sustained kidney injury, and myocardial revascularization) at 1 year were assessed. In the development set, optimal thresholds for contrast-induced AKI occurred at 6 hours for both urine NGAL (≥20 ng/mL; 97% negative predictive value and 27% positive predictive value) and sNGAL (≥179 ng/mL; 93% negative predictive value and 20% positive predictive value). Furthermore, sNGAL ≥179 ng/mL at 6 hours was an independent predictor of 1-year MAE. 1-year MAE occurred in 27/198 patients (13.5%) with sNGAL <179 ng/mL and sCr <0.3 mg/dL, in 57/193 (29.5%) patients with only sNGAL ≥179 ng/mL, and in 37/67 (55%) patients with sCr ≥0.3 mg/dL. In additional 253 patients (validation set), no patient with urine NGAL <20 ng/mL or sNGAL <179 ng/mL at 6 hours developed contrast-induced AKI. Furthermore, 6/68 (9%) patients with sNGAL <179 ng/mL and sCr increase <0.3 mg/dL had 1-year MAE versus 17/57 (30%) patients with sNGAL ≥179 ng/mL and sCr increase <0.3 mg/dL and 8/16 (50%) patients with sCr increase ≥0.3 mg/dL.
Urine NGAL <20 ng/mL and sNGAL <179 ng/mL at 6 hours are reliable markers for ruling out contrast-induced AKI. sNGAL ≥179 ng/mL at 6 hours predicts 1-year MAE.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01098032.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是急性肾损伤（AKI）的早期标志物。
在458例高危患者（开发集）中，于造影剂（CM）暴露后2、6、24和48小时评估尿NGAL和血清NGAL（sNGAL）。确定了预测造影剂诱导的AKI（CM给药后48小时血清肌酐[sCr]升高≥0.3mg/dL）的最佳阈值。评估了1年时的主要不良事件（MAE；死亡、透析、非致命性心肌梗死、持续性肾损伤和心肌血运重建）。在开发集中，造影剂诱导的AKI的最佳阈值在6小时时出现，尿NGAL（≥20ng/mL；阴性预测值97%，阳性预测值27%）和sNGAL（≥179ng/mL；阴性预测值93%，阳性预测值20%）均如此。此外，6小时时sNGAL≥179ng/mL是1年MAE的独立预测因素。1年MAE发生在sNGAL<179ng/mL且sCr<0.3mg/dL的198例患者中的27例（13.5%）、仅sNGAL≥179ng/mL的193例患者中的57例（29.5%）以及sCr≥0.3mg/dL的67例患者中的37例（55%）。在另外253例患者（验证集）中，6小时时尿NGAL<20ng/mL或sNGAL<179ng/mL的患者均未发生造影剂诱导的AKI。此外，sNGAL<179ng/mL且sCr升高<0.3mg/dL的68例患者中有6例（9%）发生1年MAE，而sNGAL≥179ng/mL且sCr升高<0.3mg/dL的57例患者中有17例（30%），sCr升高≥0.3mg/dL的16例患者中有8例（50%）。
6小时时尿NGAL<20ng/mL和sNGAL<179ng/mL是排除造影剂诱导的AKI的可靠标志物。6小时时sNGAL≥179ng/mL可预测1年MAE。
