Department of Anaesthesiology and Critical Care Medicine, Intensive Care Unit J.M.-Picard, University Hospital of Nancy - Brabois, Institut Lorrain du Cœur et des Vaisseaux Louis-Mathieu, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
Department of Vascular Surgery, University Hospital of Nancy - Brabois, 5, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France.
Anaesth Crit Care Pain Med. 2018 Aug;37(4):327-334. doi: 10.1016/j.accpm.2017.09.006. Epub 2017 Oct 12.
Plasma neutrophil gelatinase-associated lipocalin (pNGAL) has been used as a biomarker in acute kidney injury (AKI). AKI is a common postoperative complication of aortic surgery. We sought to evaluate the performance of the immediately postoperative pNGAL level in comparison with the serum creatinine (SCr) level in predicting AKI and the need for renal replacement therapy (RRT).
Prospective non-interventional study in a university hospital. Fifty patients undergoing elective or emergent major intra-abdominal aortic surgery were included. Comparisons between groups of patients with or without postoperative AKI, according to KDIGO staging, were made. Performance of NGAL was determined by examining the area under receiver operating characteristic (AUROC) curve.
The incidence of AKI was 36%. At H+2, pNGAL values in AKI and non-AKI patients, respectively, were 221 [133-278] versus 50 [50-90] ng/mL (P<0.0001), and SCr values were 115 [96-178] versus 90 [72-99] μmol/L (P<0.0008). The AUROC of pNGAL for prediction of AKI was 0.90 (95% CI: 0.81-0.98) with an optimal cutoff of 112ng/mL, a sensitivity of 83%, specificity of 84%, and positive and negative predictive values of 75% and 90%, respectively. SCr produced an AUROC curve of 0.79 (0.65-0.92) at a cutoff of 110μmol/L. The diagnostic performance of pNGAL was significantly better than that of SCr (P=0.039). PNGAL at H+2 better predicted the RRT requirement [0.96 (0.90-1.0)] compared to SCr [0.86 (0.73-0.98)], but this difference was not statistically significant.
A 2-hour postoperative determination of pNGAL outperformed SCr level in predicting postoperative AKI after major aortic surgery.
血浆中性粒细胞明胶酶相关脂质运载蛋白（pNGAL）已被用作急性肾损伤（AKI）的生物标志物。AKI 是主动脉手术后常见的术后并发症。我们试图评估即刻术后 pNGAL 水平与血清肌酐（SCr）水平在预测 AKI 和需要肾脏替代治疗（RRT）方面的表现。
这是一项在大学医院进行的前瞻性非干预性研究。共纳入 50 名接受择期或紧急大内脏主动脉手术的患者。根据 KDIGO 分期比较术后 AKI 患者和非 AKI 患者的组间差异。通过检查接受者操作特征（ROC）曲线下面积（AUROC）来确定 NGAL 的性能。
AKI 的发生率为 36%。在术后 2 小时（H+2）时，AKI 患者和非 AKI 患者的 pNGAL 值分别为 221[133-278]ng/mL 与 50[50-90]ng/mL（P<0.0001），SCr 值分别为 115[96-178]μmol/L 与 90[72-99]μmol/L（P<0.0008）。pNGAL 预测 AKI 的 AUROC 为 0.90（95%CI：0.81-0.98），最佳截断值为 112ng/mL，灵敏度为 83%，特异性为 84%，阳性和阴性预测值分别为 75%和 90%。SCr 的 AUROC 曲线在截断值为 110μmol/L 时为 0.79（0.65-0.92）。pNGAL 的诊断性能明显优于 SCr（P=0.039）。与 SCr 相比，H+2 时的 pNGAL 对 RRT 需求的预测更好[0.96（0.90-1.0）]，但这一差异无统计学意义。
在接受大主动脉手术后，与 SCr 水平相比，术后 2 小时测定 pNGAL 能更好地预测术后 AKI。
