Early diagnostic value of urinary NGAL for postoperative acute kidney injury in patients with acute Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUE Yinying , ZHANG Cui , NIU Yongsheng , SUN Fang , LI Jing ,  MU Xinwei

Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P.R.China;

Corresponding author：

MU Xinwei, Email: 18951670877@163.com

Keywords：

Neutrophil gelatinase-associated lipocalin (NGAL); acute Stanford type A aortic dissection; acute renal injury

DOI：

10.7507/1007-4848.201902019

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the early diagnostic value of urinary neutrophil gelatinase-associated lipocalin (NGAL) for acute kidney injury (AKI) after acute Stanford type A aortic dissection. Methods From January 2018 to December 2018, the clinical data of 50 patients who underwent open surgery for acute Stanford type A aortic dissection were analyzed in Nanjing First Hospital. Urine specimens were collected before and 2 hours after the aortic dissection surgery. Patients were divided into an AKI group (n=27) and a non-AKI group (n=23) according to the Kidney Disease Improving Global Outcomes criteria. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of urine NGAL. Results The incidence of postoperative AKI was 54.00% (27/50). There was a statistically significant difference between the two groups in serum creatinine concentration at 2 hours after surgery and urinary NGAL concentration before the surgery (P<0.05). The area under ROC curve of preoperative urinary NGAL concentration was 0.626. When cut-off value was 43 ng/mL, the sensitivity was 40.7%, specificity was 95.7%. The area under ROC curve of urinary NGAL concentration at 2 hours after surgery was 0.655, and when the cut-off value was 46.95 ng/mL, the sensitivity was 63.0%, specificity was 78.3%. Conclusion Urine NGAL can predict postoperative AKI in patients with acute Stanford type A aortic dissection, but its value is limited.

Citation： XUE Yinying, ZHANG Cui, NIU Yongsheng, SUN Fang, LI Jing, MU Xinwei. Early diagnostic value of urinary NGAL for postoperative acute kidney injury in patients with acute Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(11): 1103-1106. doi: 10.7507/1007-4848.201902019 Copy

1.	Wang J, Yu W, Zhai G, et al. Independent risk factors for postoperative AKI and the impact of the AKI on 30-day postoperative outcomes in patients with type A acute aortic dissection: an updated meta-analysis and meta-regression. J Thorac Dis, 2018, 10(5): 2590-2598.
2.	Hu J, Chen R, Liu S, et al. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(1): 82-89.
3.	Fuhrman DY, Kellum JA. Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury. Curr Opin Anaesthesiol, 2017, 30(1): 60-65.
4.	Xu JR, Zhu JM, Jiang J, et al. Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltimore), 2015, 94(45): e2025.
5.	Bataille A, Tiepolo A, Robert T, et al. Reference change values of plasma and urine NGAL in cardiac surgery with cardiopulmonary bypass. Clin Biochem, 2017, 50(18): 1098-1103.
6.	Elmedany SM, Naga SS, Elsharkawy R, et al. Novel urinary biomarkers and the early detection of acute kidney injury after open cardiac surgeries. J Crit Care, 2017, 40: 171-177.
7.	Ho J, Tangri N, Komenda P, et al. Urinary, plasma, and serum biomarkers' utility for predicting acute kidney injury associated with cardiac surgery in adults: a meta-analysis. Am J Kidney Dis, 2015, 66(6): 993-1005.
8.	Xu JR, Teng J, Fang Y, et al. The risk factors and prognosis of acute kidney injury after cardiac surgery: a prospective cohort study of 4007 cases. Zhonghua Nei Ke Za Zhi, 2012, 51(12): 943-947.
9.	Murray PT, Mehta RL, Shaw A, et al. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int, 2014, 85(3): 513-521.
10.	Haase M, Devarajan P, Haase-Fielitz A, et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies. J Am Coll Cardiol, 2011, 57(17): 1752-1761.
11.	Yeung KK, Richir M, Hanrath P, et al. Infrarenal aortic-clamping after renal ischaemia aggravates acute renal failure. Eur J Clin Invest, 2011, 41(6): 605-615.
12.	Parikh CR, Butrymowicz I, Yu A, et al. Urine stability studies for novel biomarkers of acute kidney injury. Am J Kidney Dis, 2014, 63(4): 567-572.
13.	Paragas N, Qiu A, Zhang Q, et al. The NGAL reporter mouse detects the response of the kidney to injury in real time. Nat Med, 2011, 17(2): 216-222.
14.	Jain V, Mehta Y, Gupta A, et al. The role of neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in patients undergoing off-pump coronary artery bypass graft: A pilot study. Ann Card Anaesth, 2016, 19(2): 225-230.
15.	Moriyama T, Hagihara S, Shiramomo T, et al. Comparison of three early biomarkers for acute kidney injury after cardiac surgery under cardiopulmonary bypass. J Intensive Care, 2016, 4: 41.
16.	Lacquaniti A, Giardina M, Lucisano S, et al. Neutrophil gelatinase-associated lipocalin (NGAL) and endothelial progenitor cells (EPCs) evaluation in aortic aneurysm repair. Curr Vasc Pharmacol, 2013, 11(6): 1001-1010.

1. Wang J, Yu W, Zhai G, et al. Independent risk factors for postoperative AKI and the impact of the AKI on 30-day postoperative outcomes in patients with type A acute aortic dissection: an updated meta-analysis and meta-regression. J Thorac Dis, 2018, 10(5): 2590-2598.
2. Hu J, Chen R, Liu S, et al. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(1): 82-89.
3. Fuhrman DY, Kellum JA. Epidemiology and pathophysiology of cardiac surgery-associated acute kidney injury. Curr Opin Anaesthesiol, 2017, 30(1): 60-65.
4. Xu JR, Zhu JM, Jiang J, et al. Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltimore), 2015, 94(45): e2025.
5. Bataille A, Tiepolo A, Robert T, et al. Reference change values of plasma and urine NGAL in cardiac surgery with cardiopulmonary bypass. Clin Biochem, 2017, 50(18): 1098-1103.
6. Elmedany SM, Naga SS, Elsharkawy R, et al. Novel urinary biomarkers and the early detection of acute kidney injury after open cardiac surgeries. J Crit Care, 2017, 40: 171-177.
7. Ho J, Tangri N, Komenda P, et al. Urinary, plasma, and serum biomarkers' utility for predicting acute kidney injury associated with cardiac surgery in adults: a meta-analysis. Am J Kidney Dis, 2015, 66(6): 993-1005.
8. Xu JR, Teng J, Fang Y, et al. The risk factors and prognosis of acute kidney injury after cardiac surgery: a prospective cohort study of 4007 cases. Zhonghua Nei Ke Za Zhi, 2012, 51(12): 943-947.
9. Murray PT, Mehta RL, Shaw A, et al. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney Int, 2014, 85(3): 513-521.
10. Haase M, Devarajan P, Haase-Fielitz A, et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies. J Am Coll Cardiol, 2011, 57(17): 1752-1761.
11. Yeung KK, Richir M, Hanrath P, et al. Infrarenal aortic-clamping after renal ischaemia aggravates acute renal failure. Eur J Clin Invest, 2011, 41(6): 605-615.
12. Parikh CR, Butrymowicz I, Yu A, et al. Urine stability studies for novel biomarkers of acute kidney injury. Am J Kidney Dis, 2014, 63(4): 567-572.
13. Paragas N, Qiu A, Zhang Q, et al. The NGAL reporter mouse detects the response of the kidney to injury in real time. Nat Med, 2011, 17(2): 216-222.
14. Jain V, Mehta Y, Gupta A, et al. The role of neutrophil gelatinase-associated lipocalin in predicting acute kidney injury in patients undergoing off-pump coronary artery bypass graft: A pilot study. Ann Card Anaesth, 2016, 19(2): 225-230.
15. Moriyama T, Hagihara S, Shiramomo T, et al. Comparison of three early biomarkers for acute kidney injury after cardiac surgery under cardiopulmonary bypass. J Intensive Care, 2016, 4: 41.
16. Lacquaniti A, Giardina M, Lucisano S, et al. Neutrophil gelatinase-associated lipocalin (NGAL) and endothelial progenitor cells (EPCs) evaluation in aortic aneurysm repair. Curr Vasc Pharmacol, 2013, 11(6): 1001-1010.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early diagnostic value of urinary NGAL for postoperative acute kidney injury in patients with acute Stanford type A aortic dissection

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