Mosa Osama F
Clinical Biochemistry and Laboratory Biomedicine, Health Science College at Leith, Umm Al Qura University, Al-Leith, Saudi Arabia.
Kidney Dis (Basel). 2018 Nov;4(4):246-254. doi: 10.1159/000490246. Epub 2018 Jul 4.
Acute kidney injury (AKI) is a common complication following cardiac surgery and percutaneous coronary interventions, with an estimated incidence rate around 30%, depicted by long-term intensive care unit stay and culminating renal dysfunction over time, triggering either perpetual renal damage evolving to chronic kidney disease/end-stage renal disease transitions or high vulnerability for sudden death after surgery. The classical diagnosis of AKI is based on a sharp rise in serum creatinine that takes at least 48 h to be visible and is associated with multiple nonrenal factors.
We aimed to evaluate the predictive performance of both neutrophil gelatinase-associated lipocalin (NGAL) and Klotho for AKI in patients who underwent cardiothoracic surgery using cardiopulmonary bypass (CPB).
Out of the 182 patients included in the study, 65 had AKI and 117 had non-AKI according to the Kidney Disease: Improving Global Outcomes criteria relying on serum creatinine levels. Baseline serum NGAL was 103.5 ± 41.69 μg/L in the AKI group compared to 79.12 ± 48.02 μg/L in the non-AKI group ( < 0.01) and then manifested a peak-fall-rise pattern until 48 h of CPB, with a more remarkable change in the AKI than in the non-AKI group. ROC curve analysis for all measured biomarkers after 2 h of CPB showed that serum NGAL (0.819, > 75% cutoff, 83.5% accuracy) came after serum creatinine (0.864, > 140% cutoff, 85% accuracy), and troponin I was poorer than both (0.606, > 5.5% cutoff, 60% accuracy). Furthermore, multivariate analysis showed that preoperative serum NGAL, preoperative eGFR ≤60 mL/min/1.73 m, and arterial hypertension were possible risk factors for AKI with adverse outcomes.
Our study suggests the role of preoperative serum NGAL as a prognostic tool for renal consequences after cardiac surgery. Besides, postoperative serum NGAL is a sensitive marker for AKI, but is less specific than serum creatinine. Troponin I is considered to be a risk confirmatory tool and may help in the prediction of AKI. However, its diagnostic utility is restricted due to age-dependent cutoff values and poor standardization and harmonization because of interassay variations.
急性肾损伤（AKI）是心脏手术和经皮冠状动脉介入治疗后的常见并发症，估计发病率约为30%，表现为长期入住重症监护病房以及随着时间推移肾功能逐渐恶化，引发永久性肾损伤并发展为慢性肾脏病/终末期肾病，或导致术后猝死的高风险。AKI的经典诊断基于血清肌酐的急剧升高，这至少需要48小时才能显现，且与多种非肾因素有关。
我们旨在评估中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和Klotho对接受体外循环（CPB）心脏手术患者发生AKI的预测性能。
根据基于血清肌酐水平的改善全球肾脏病预后组织标准，在纳入研究的182例患者中，65例发生AKI，117例未发生AKI。AKI组的基线血清NGAL为103.5±41.69μg/L，非AKI组为79.12±48.02μg/L（P<0.01），然后在CPB至48小时期间呈现先升高后下降再升高的模式，AKI组的变化比非AKI组更显著。CPB 2小时后对所有测量的生物标志物进行ROC曲线分析显示，血清NGAL（曲线下面积为0.819，截断值>75%，准确率83.5%）仅次于血清肌酐（曲线下面积为0.864，截断值>140%，准确率85%），肌钙蛋白I比两者都差（曲线下面积为0.606，截断值>5.5%，准确率60%）。此外，多因素分析显示术前血清NGAL、术前估算肾小球滤过率（eGFR）≤60 mL/min/1.73 m²以及动脉高血压可能是导致不良结局的AKI危险因素。
我们的研究表明术前血清NGAL可作为心脏手术后肾脏预后的预测工具。此外，术后血清NGAL是AKI的敏感标志物，但特异性低于血清肌酐。肌钙蛋白I被认为是一种风险确认工具，可能有助于预测AKI。然而，由于其诊断效用受年龄相关截断值的限制，且因检测间差异导致标准化和一致性较差。
