title: Neutrophil gelatinase-associated lipocalin as a predictor of complications and mortality in patients undergoing non-cardiac major surgery.
abstract: BACKGROUND
  We tested the hypothesis that urinary and serum neutrophil gelatinase-associated lipocalins (NGAL) early after non-cardiac major surgery predict postoperative acute kidney injury (AKI), complications and mortality.
  
  
  METHODS
  We studied 74 patients undergoing orthopedic, vascular and abdominal surgery lasting ≥2 h. NGAL was measured in preoperative, as well as 2- and 6-hour postoperative samples. The primary outcome was AKI. Secondary outcome was postoperative infection and death.
  
  
  RESULTS
  10 patients (13.5%) developed AKI, 19 (26%) reached secondary outcomes, of whom 5 (7%) died. Serum NGAL was significantly higher in patients with diabetes and chronic kidney disease (CKD). No significant correlation was detected between serum or urine NGAL and subsequent development of AKI. Urine NGAL at 6 h and serum NGAL at 2 and 6 h were strongly correlated with postoperative infection and death (p = 0.004, p = 0.013 and p = 0.001, respectively).
  
  
  CONCLUSIONS
  Our data suggest that in the general surgical population, NGAL could serve as a potent early biomarker for postoperative infection, and that the presence of CKD and diabetes mellitus is associated with higher levels of NGAL and may influence its predictive value.
authors.affiliation: Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit@szmc.org.il
authors.forename: Linda
authors.initials: L
authors.lastname: Shavit
authors.forename: Irena
authors.initials: I
authors.lastname: Dolgoker
authors.forename: Heftziba
authors.initials: H
authors.lastname: Ivgi
authors.forename: Marc
authors.initials: M
authors.lastname: Assous
authors.forename: Itzchak
authors.initials: I
authors.lastname: Slotki
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000209:Acute-Phase Proteins / Q000032:analysis* / Q000652:urine; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D003920:Diabetes Mellitus; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000032:analysis* / Q000097:blood / Q000652:urine; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality*; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000032:analysis* / Q000097:blood / Q000652:urine; D051436:Renal Insufficiency, Chronic; D015996:Survival Rate
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins