Department of Emergency Medicine, College of Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, South Korea.
Department of Emergency Medicine, Chung-Ang University, College of Medicine, Seoul, South Korea.
BMC Nephrol. 2020 Sep 7;21(1):389. doi: 10.1186/s12882-020-02054-7.
Serum neutrophil gelatinase-associated lipocalin (NGAL) could be used as a predictive marker of acute kidney injury (AKI) in patients with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) who are managed with targeted temperature management (TTM). However, the NGAL measurement timepoints vary from immediately after ROSC to several days later. The primary objective of this study was to determine an association between AKI and NGAL, both immediately (ROSC-NGAL) and 3 h after ROSC (3 h-NGAL), in OHCA patients with TTM. The secondary objective was to ascertain the association between NGAL levels in the early post-ROSC phase and the neurologic outcomes at discharge.
This prospective observational study was conducted between January 2016 and December 2018 and enrolled adult OHCA patients (≥18 years) with TTM after ROSC. The serum NGAL level was measured both immediately and 3 h after ROSC. Univariate and multivariate analyses were performed to identify the associations between AKI, poor neurologic outcome, and NGAL.
Among 861 OHCA patients, 89 patients were enrolled. AKI occurred in 48 (55.1%) patients. On multivariate logistic regression analysis, 3 h-NGAL was significantly associated with AKI (odds ratio [OR] 1.022; 95% confidence interval [CI] 1.009-1.035; p = 0.001). The area under the receiver operating characteristic curve of 3 h-NGAL for AKI was 0.910 (95% CI 0.830-0.960), and a cut-off value of 178 ng/mL was identified. Both ROSC-NGAL and 3 h-NGAL were not significantly associated with poor neurologic outcome on multivariate logistic regression analysis (ROSC-NGAL; OR 1.017; 95% CI 0.998-1.036; p = 0.084, 3 h-NGAL; OR 0.997; 95% CI 0.992-1.001; p = 0.113).
The serum NGAL concentration measured 3 h after ROSC is an excellent early predictive marker for AKI in OHCA patients treated with TTM. Future research is needed to identify the optimal measurement timepoint to establish NGAL as a predictor of neurologic outcome and to validate the findings of this research.
血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）可作为院外心脏骤停（OHCA）后恢复自主循环（ROSC）患者接受目标温度管理（TTM）的急性肾损伤（AKI）的预测标志物。然而，NGAL 的测量时间点从 ROSC 后即刻到数天不等。本研究的主要目的是确定 TTM 治疗的 OHCA 患者中 AKI 与 NGAL 之间的关联，包括即刻（ROSC-NGAL）和 ROSC 后 3 小时（3h-NGAL）。次要目的是确定 ROSC 后早期 NGAL 水平与出院时神经功能结局之间的关联。
这是一项前瞻性观察研究，于 2016 年 1 月至 2018 年 12 月进行，纳入了接受 ROSC 后接受 TTM 的成年 OHCA 患者（≥18 岁）。在 ROSC 后即刻和 3 小时测量血清 NGAL 水平。进行单变量和多变量分析以确定 AKI、不良神经结局与 NGAL 之间的关联。
在 861 名 OHCA 患者中，纳入了 89 名患者。48 名（55.1%）患者发生 AKI。多变量逻辑回归分析显示，3h-NGAL 与 AKI 显著相关（优势比[OR] 1.022；95%置信区间[CI] 1.009-1.035；p=0.001）。3h-NGAL 对 AKI 的受试者工作特征曲线下面积为 0.910（95%CI 0.830-0.960），确定 178ng/mL 为截断值。多变量逻辑回归分析显示，ROSC-NGAL 和 3h-NGAL 均与不良神经结局无显著相关性（ROSC-NGAL；OR 1.017；95%CI 0.998-1.036；p=0.084，3h-NGAL；OR 0.997；95%CI 0.992-1.001；p=0.113）。
ROSC 后 3 小时测量的血清 NGAL 浓度是 TTM 治疗 OHCA 患者 AKI 的极佳早期预测标志物。需要进一步研究以确定最佳测量时间点，以确立 NGAL 作为神经功能结局的预测因子，并验证本研究的结果。
