Kanchi Muralidhar, Manjunath R, Massen Jos, Vincent Lloyd, Belani Kumar
Department of Anesthesia and Intensive Care, Narayana Hrudayalaya Hospital, Bengaluru, Karnataka, India.
Department of Anesthesia, Narayana Hrudayalaya Hospital, Bengaluru, Karnataka, India.
Ann Card Anaesth. 2017 Jul-Sep;20(3):297-302. doi: 10.4103/aca.ACA_48_17.
Acute kidney injury (AKI) following cardiac surgery is a major complication resulting in increased morbidity, mortality, and economic burden. In this study, we assessed the usefulness of estimating serum neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker in predicting AKI in patients with stable chronic kidney disease (CKD) and undergoing off-pump coronary artery bypass grafting (OP-CABG).
We prospectively studied sixty nondialysis-dependent CKD patients with estimated glomerular filtration rate <60 ml/min/1.73 m2 who required elective OP-CABG. Patients were randomized into two groups, Group D received dopamine infusion at 2 μg/kg/min following anesthesia induction till the end of the surgery and Group P did not receive any intervention. Serum creatinine, NGAL, brain natriuretic peptide, and troponin-I were estimated at specified intervals before, during, and after surgery. The results of the study patients were also compared to a simultaneous matched cohort control of thirty patients (Group A) without renal dysfunction who underwent OP-CABG.
No patient required renal replacement therapy, and no mortality was observed during perioperative and hospitalization period. Six patients from control group (n = 30), ten patients from placebo group (n = 30), and 12 patients from dopamine group (n = 30) developed stage 1 AKI. However, we did not observe any stage 2 and stage 3 AKI among all the groups. There was a significant increase in serum NGAL levels at the end of surgery and 24 h postoperatively in placebo and dopamine groups as compared to the control.
The measurement of NGAL appears to predict the occurrence of AKI after OP-CAB surgery. However, large multicentric studies may be required to confirm the findings of this study.
心脏手术后的急性肾损伤（AKI）是一种主要并发症，会导致发病率、死亡率和经济负担增加。在本研究中，我们评估了估算血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）作为生物标志物在预测稳定的慢性肾脏病（CKD）且接受非体外循环冠状动脉搭桥术（OP-CABG）患者发生AKI中的作用。
我们前瞻性研究了60例估算肾小球滤过率<60 ml/min/1.73 m²且需要择期OP-CABG的非透析依赖性CKD患者。患者被随机分为两组，D组在麻醉诱导后至手术结束期间以2 μg/kg/min的速度输注多巴胺，P组未接受任何干预。在手术前、手术期间和手术后的特定时间间隔估算血清肌酐、NGAL、脑钠肽和肌钙蛋白I。还将研究患者的结果与30例无肾功能障碍且接受OP-CABG的同期匹配队列对照组（A组）进行比较。
没有患者需要肾脏替代治疗，围手术期和住院期间未观察到死亡病例。对照组（n = 30）中有6例患者、安慰剂组（n = 30）中有10例患者和多巴胺组（n = 30）中有12例患者发生了1期AKI。然而，我们在所有组中均未观察到2期和3期AKI。与对照组相比，安慰剂组和多巴胺组在手术结束时和术后24小时血清NGAL水平显著升高。
NGAL的测量似乎可以预测OP-CAB手术后AKI的发生。然而，可能需要大型多中心研究来证实本研究的结果。
