Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Scand J Clin Lab Invest. 2022 Sep;82(5):410-418. doi: 10.1080/00365513.2022.2114105. Epub 2022 Aug 29.
Acute kidney injury (AKI) is a serious complication in as much as half of the patients undergoing cardiac surgery, and early diagnosis and treatment are of the utmost importance. There is a need for robust biomarkers that can detect cardiac surgery-associated AKI (CSA-AKI) prior to rise in plasma creatinine, which typically occurs at least 48 h postoperatively. We compared pre- and 4, 12 and 48 h postoperative plasma (P) neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, urea and creatinine, and urine (U) NGAL, as markers of AKI, in 49 patients (67% men, median age 65 years) scheduled for elective cardiac surgery (e.g. coronary artery bypass graft and/or valve replacement surgery) with the use of extracorporeal circulation. Patients with preoperative sepsis, renal replacement therapy, or estimated glomerular filtration rate <30 mL/min/1.73m were excluded. P- and U-NGAL were measured using the Roche Modular P (Roche Diagnostics) NGAL immunoassay. According to AKIN/KDIGO criteria, nine patients (18%) were diagnosed with CSA-AKI. Compared to patients without CSA-AKI, these patients had significantly higher P-NGAL and P-cystatin C values 4 h (-values .002 and <.001) and 12 h (-values <.001 and <.001) postoperatively. The same differences were not observed for U-NGAL. Patients with AKI also had significantly higher P-creatinine 4 and 12 h postoperatively (-values .001 and <.001), however the rise in P-creatinine was just above the upper reference limit. In conclusion, plasma NGAL and cystatin C seem to detect CSA-AKI earlier than the more commonly used biomarkers creatinine and urea.
急性肾损伤（AKI）是接受心脏手术的患者中多达一半的严重并发症，早期诊断和治疗至关重要。需要有强大的生物标志物，可以在血浆肌酐升高之前检测到与心脏手术相关的 AKI（CSA-AKI），而肌酐升高通常至少在术后 48 小时后才会发生。我们比较了 49 名接受择期心脏手术（例如冠状动脉旁路移植术和/或瓣膜置换术）并使用体外循环的患者术前和术后 4、12 和 48 小时的血浆（P）中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素 C、尿素和肌酐以及尿液（U）NGAL，作为 AKI 的标志物。排除了术前脓毒症、肾脏替代治疗或估计肾小球滤过率 <30mL/min/1.73m 的患者。使用罗氏 Modular P（罗氏诊断）NGAL 免疫测定法测量 P-和 U-NGAL。根据 AKIN/KDIGO 标准，9 名患者（18%）被诊断为 CSA-AKI。与没有 CSA-AKI 的患者相比，这些患者术后 4 小时（-值.002 和 <.001）和 12 小时（-值 <.001 和 <.001）的 P-NGAL 和 P-胱抑素 C 值显着更高。未观察到 U-NGAL 的相同差异。AKI 患者术后 4 和 12 小时的 P-肌酐值也显着升高（-值.001 和 <.001），但 P-肌酐的升高仅略高于参考上限。总之，与更常用的生物标志物肌酐和尿素相比，血浆 NGAL 和胱抑素 C 似乎更早地检测到 CSA-AKI。
