title: Neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of cardiac surgery associated acute kidney injury.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common complication after cardiac surgery. Neutrophil gelatinase-associated lipocalin (NGAL) may be an early biomarker for cardiac surgery-associated (CSA) AKI. We investigated whether increased urinary NGAL concentrations were predictive of AKI within 4 days after surgery and of mortality within 9 months.
  
  
  METHODS
  Consecutive patients (n = 141) undergoing major cardiac surgery were included. Creatinine, blood urea nitrogen, cystatin C and urinary NGAL were measured before, 4 hours and 4 days after extracorporeal circulation.
  
  
  RESULTS
  AKI was observed in 47 (33.3%) patients. The 4-hour urinary NGAL measurement was an independent predictor of stage 2 and 3 AKI (AUC 0.901; 95% CI 0.81-0.99). Patients with AKI had a higher 9-month mortality rate (19.1% vs. 3.2%; logrank 10.9; P = 0.001; HR 19.8; 95% CI 3.7-107.1). Urinary NGAL was not predictive of mortality within 9 months after surgery.
  
  
  CONCLUSIONS
  Urinary NGAL is a biomarker for very early risk stratification of AKI after cardiac surgery and may be useful as a basis for early interventional strategies to prevent CSA-AKI.
authors.affiliation: Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. c.liebetrau@kerckhoff-klinik.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.forename: Oliver
authors.initials: O
authors.lastname: Dörr
authors.forename: Heike
authors.initials: H
authors.lastname: Baumgarten
authors.forename: Luise
authors.initials: L
authors.lastname: Gaede
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szardien
authors.forename: Johannes
authors.initials: J
authors.lastname: Blumenstein
authors.forename: Andreas
authors.initials: A
authors.lastname: Rolf
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Holger
authors.initials: H
authors.lastname: Nef
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000652:urine; D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D019540:Area Under Curve; D001806:Blood Urea Nitrogen; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D005919:Glomerular Filtration Rate; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve
chemical_list: D000209:Acute-Phase Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine