Plasma neutrophil gelatinase-associated lipocalin and acute postoperative kidney injury in adult cardiac surgical patients

Abstract

Background: Acute kidney injury (AKI) after coronary artery bypass graft (CABG) surgery is associated with increased postoperative morbidity and mortality. We hypothesized that increased plasma neutrophil gelatinase-associated lipocalin (NGAL) measured immediately after separating from cardiopulmonary bypass (CPB) would predict AKI after CABG surgery.

Methods: In a retrospective observational study, we examined the value of plasma NGAL measured after CPB for predicting the risk of developing AKI (defined as a > or = 50% increase in serum creatinine from preoperative levels) in 879 patients after CABG surgery using multivariable logistic regression. Area under the curve of receiver operating characteristic curves was analyzed to assess sensitivities, specificities, and cutoff points for postoperative plasma NGAL levels to predict AKI.

Results: Seventy-five patients (8.6%) developed postoperative AKI. Plasma NGAL levels measured after CPB were higher in patients who subsequently developed AKI than in those who did not (AKI: 268.8 ng/mL [207.5-459.5 ng/mL], median [interquartile range], vs no AKI: 238.4 ng/mL [172.0-319.1 ng/mL]; P < 0.001) and remained higher through postoperative day 4. An optimal serum plasma NGAL cutoff of 353.5 ng/mL at the post-CPB time point had a sensitivity of 38.7%, specificity of 81.5%, and a positive predictive value of 16.3% for predicting AKI. In our multivariate regression model, post-CPB plasma NGAL levels >353.5 ng/mL were independently associated with postoperative AKI (odds ratio, 2.3; 95% confidence interval, 1.5-6.5; P = 0.002).

Conclusion: An early increase of post-CPB plasma NGAL is associated with AKI in adult patients undergoing CABG surgery, although the sensitivity is low. Therefore, assessing early plasma NGAL alone has limited utility for predicting AKI in this patient population.

Figures

Figure 1

Perioperative serum creatinine levels in patients who developed acute postoperative kidney injury and in those who did not after coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Data represented as scatter plot with median and interquartile range and dichotomized by patients who did not develop acute kidney injury (AKI) (Normal) and those who did (AKI). Serum creatinine measured in increments of 0.1 mg/dL. P values represent differences between Normal and AKI columns at each corresponding time point. Preop = preoperative; POD = postoperative day.

Figure 2

Perioperative plasma neutrophil gelatinase-associated lipocalin levels in patients who developed acute postoperative kidney injury and in those who did not after coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). Data represented as scatter plot with median and interquartile range and dichotomized by patients who did not develop acute kidney injury (AKI) (Normal) and those who did (AKI). P values represent differences between Normal and AKI columns at each corresponding time point. Preop = preoperative; post-CPB = immediately after separating from cardiopulmonary bypass; POD = postoperative day.

Figure 3

Receiver operating characteristic curves for postoperative plasma neutrophil gelatinase-associated lipocalin (NGAL) levels to predict acute postoperative kidney injury after coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). POD = postoperative day; AUC = area under the curve; CI = confidence interval.

Figure 4

Perioperative serum creatinine levels in patients with plasma neutrophil gelatinase-associated lipocalin (NGAL) levels more than or less than the determined optimal cutoff value of 353.5 ng/mL measured immediately after cardiopulmonary bypass (CBP). Data represented as scatter plot with median and interquartile range. POD = postoperative day.