Department of Anesthesiology and Reanimation, Pendik Research and Training Hospital, Marmara University Medical Faculty, Fevzi Cakmak Mah, Muhsin Yazicioglu Cad. No: 10, 34899, Ustkaynarca, Pendik, Istanbul, Turkey.
Ir J Med Sci. 2022 Jun;191(3):1297-1303. doi: 10.1007/s11845-021-02865-z. Epub 2021 Nov 25.
Elderly patients are at increased risk of developing acute kidney injury (AKI) following major surgery and rapid diagnosis is essential.
This study aimed to examine the potential utility of plasma neutrophil gelatinase associated lipocalin levels in early prediction of AKI in geriatric patients undergoing laparotomic oncological surgery.
This prospective single-center cohort study included 60 geriatric patients (≥ 65 years of age) that underwent major oncologic surgery with laparotomy. Perioperative measurements of plasma creatinine, blood urinary nitrogen, plasma lactate, urine output, and neutrophil gelatinase associated lipocalin (NGAL) were made. Patients were followed for AKI development, which is the primary outcome measure, and predictive role of NGAL was investigated.
At 48 h follow-up, AKI developed in 13 patients (21.7%). Significant differences in creatinine (p < 0.001), NGAL (p < 0.001), and urine output levels (p = 0.001) were evident over time between the two groups. High NGAL measurements at 6 and 24 h after surgery seem to be highly predictive of AKI development. At 6 h, a plasma NGAL level greater than 71.8 ng/mL has a sensitivity and specificity of 85% and 81% in predicting subsequent AKI development.
Plasma NGAL levels seem to represent an early and reliable marker for AKI in elderly patients undergoing laparotomic surgery with the potential to allow early diagnosis and prevent further renal deterioration. Further confirmatory studies are warranted.
The study was registered to ClinicalTrials.gov (number, NCT05030727).
Elderly patients are at increased risk of postoperative acute kidney injury (AKI). This study shows that plasma neutrophil gelatinase associated lipocalin is a helpful marker to predict AKI in elderly patients undergoing laparotomic major surgery, which will allow early diagnosis and prevent further renal deterioration in this vulnerable patient group.
老年患者在接受大手术后发生急性肾损伤（AKI）的风险增加，因此快速诊断至关重要。
本研究旨在探讨血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平在预测老年剖腹手术的肿瘤患者 AKI 中的潜在作用。
本前瞻性单中心队列研究纳入 60 名（≥65 岁）接受剖腹手术的大型肿瘤手术的老年患者。在围手术期测量血浆肌酐、血液尿素氮、血浆乳酸、尿量和 NGAL。对患者进行 AKI 发展的随访，这是主要的观察指标，并研究了 NGAL 的预测作用。
在 48 小时的随访中，13 名患者（21.7%）出现 AKI。两组之间在肌酐（p < 0.001）、NGAL（p < 0.001）和尿量水平（p = 0.001）方面存在显著差异。手术后 6 小时和 24 小时的高 NGAL 测量似乎对 AKI 的发展具有高度预测性。在 6 小时时，血浆 NGAL 水平大于 71.8ng/ml 对随后发生 AKI 的预测具有 85%的敏感性和 81%的特异性。
血浆 NGAL 水平似乎代表了接受剖腹手术的老年患者 AKI 的早期和可靠标志物，有可能实现早期诊断并防止进一步的肾损伤。需要进一步的验证性研究。
该研究在 ClinicalTrials.gov 注册（编号：NCT05030727）。
老年患者术后发生急性肾损伤（AKI）的风险增加。本研究表明，血浆中性粒细胞明胶酶相关脂质运载蛋白是预测老年患者剖腹手术重大手术 AKI 的有用标志物，这将使该脆弱患者群体能够实现早期诊断并防止进一步的肾损伤。
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