title: Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery--a prospective cohort study.
abstract: OBJECTIVE
  To compare the value of novel with conventional serum biomarkers in the prediction of acute kidney injury (AKI) in adult cardiac surgical patients according to preoperative renal function.
  
  
  METHODS
  Single-center, prospective observational study.
  
  
  METHODS
  Tertiary hospital.
  
  
  METHODS
  One hundred adult cardiac surgical patients.
  
  
  RESULTS
  We measured concentrations of plasma neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C, and creatinine and urea at baseline, on arrival in the intensive care unit (ICU) and at 24 hours postoperatively. We assessed such biomarkers in relation to the development of AKI (>50% increase in creatinine from baseline) and to a composite end point (need for renal replacement therapy and in-hospital mortality). We defined an area under the receiver operating characteristic curve of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. On arrival in ICU, plasma NGAL and serum cystatin C were of good predictive value, but creatinine and urea were of poor predictive value. After exclusion of patients with preoperative renal impairment (estimated glomerular filtration rate <60 mL/min), the predictive performance for AKI of all renal biomarkers on arrival in ICU remained unchanged except for cystatin C, which was of fair value in such patients. At 24 hours postoperatively, all renal biomarkers were of good predictive value. On arrival in ICU, novel biomarkers were superior to conventional biomarkers (p < 0.05). Plasma NGAL (p = 0.015) and serum cystatin C (p = 0.007) were independent predictors of AKI and of excellent value in the prediction of the composite end point.
  
  
  CONCLUSIONS
  Early postoperative measurement of plasma NGAL was of good value in identifying patients who developed AKI after adult cardiac surgery. Plasma NGAL and serum cystatin C were superior to conventional biomarkers in the prediction of AKI and were also of prognostic value in this setting.
authors.affiliation: Department of Intensive Care, Austin Health, Melbourne, Australia.
authors.forename: Anja
authors.initials: A
authors.lastname: Haase-Fielitz
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: David
authors.initials: D
authors.lastname: Story
authors.forename: George
authors.initials: G
authors.lastname: Matalanis
authors.forename: Duska
authors.initials: D
authors.lastname: Dragun
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology; D000209:Acute-Phase Proteins; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D003422:Critical Care; D055316:Cystatin C / Q000097:blood; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007668:Kidney / Q000293:injuries*; D007677:Kidney Function Tests; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood; D017582:Renal Replacement Therapy; D018570:Risk Assessment; D014508:Urea / Q000097:blood
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D014508:Urea; D003404:Creatinine