Neutrophil gelatinase-associated lipocalin levels during extracorporeal membrane oxygenation in critically ill children with congenital heart disease: preliminary experience.
OBJECTIVE
To evaluate diagnostic and prognostic significance of neutrophil gelatinase-associated lipocalin during extracorporeal membrane oxygenation in children with congenital heart disease.


METHODS
Prospective observational study.


METHODS
Pediatric cardiac intensive care unit.


METHODS
Ten pediatric patients with congenital heart disease requiring venoarterial extracorporeal membrane oxygenation for postoperative cardiorespiratory support were prospectively enrolled.


METHODS
None.


RESULTS
Five patients were successfully weaned from extracorporeal membrane oxygenation and survived to intensive care unit discharge; five children died during extracorporeal therapy or within 12 hrs from extracorporeal membrane oxygenation stop. Continuous renal replacement therapy after extracorporeal membrane oxygenation start was indicated for three patients. When patients on continuous venovenous hemofiltration were compared with patients not on continuous venovenous hemofiltration, diuretic administration was lower (1.5 vs. 10 mg/kg/day), extracorporeal membrane oxygenation duration was longer (7 [range, 6-14]) vs. 4 [range, 3-8] days), and survival decreased from 60% (four of seven) to 33% (one of three). Neutrophil gelatinase-associated lipocalin levels were higher at the first extracorporeal membrane oxygenation day in patients who underwent continuous venovenous hemofiltration, 285 (range, 181-513) vs. 130 (range, 81-277) ng/mL, in patients who did not undergo continuous venovenous hemofiltration (p = .045). Neutrophil gelatinase-associated lipocalin levels remained higher among patients on continuous venovenous hemofiltration than others throughout the examined extracorporeal membrane oxygenation period (p = .0007), whereas creatinine levels tended to be equivalent between the two groups (p = .38). However, a trend toward increasing neutrophil gelatinase-associated lipocalin levels was noticed also in patients not on continuous venovenous hemofiltration.


CONCLUSIONS
Neutrophil gelatinase-associated lipocalin levels at the first extracorporeal membrane oxygenation day may have predictive value for continuous venovenous hemofiltration. During the course of extracorporeal membrane oxygenation support, creatinine levels were normalized in patients with acute kidney injury undergoing continuous venovenous hemofiltration; in these patients, neutrophil gelatinase-associated lipocalin levels may provide further information on kidney injury.
Division of Pediatric Cardiac Anesthesia/Intensive Care Unit, Bambino Gesù Pediatric Hospital, Rome, Italy. z.ricci@libero.it
Zaccaria
Z
Ricci
Stefano
S
Morelli
Isabella
I
Favia
Cristiana
C
Garisto
Gianluca
G
Brancaccio
Sergio
S
Picardo
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D000209:Acute-Phase Proteins / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D000071068:Lipocalin-2; D054834:Lipocalins / Q000032:analysis / Q000378:metabolism*; D008297:Male; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000378:metabolism*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins