title: Postoperative neutrophil gelatinase-associated lipocalin predicts acute kidney injury after pediatric cardiac surgery*.
abstract: OBJECTIVE
  We investigated the temporal pattern and predictive value of neutrophil gelatinase-associated lipocalin for early identification of acute kidney injury in children undergoing cardiac surgery.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  One PICU in a tertiary medical center in Madrid, Spain.
  
  
  METHODS
  One hundred six children older than 15 days and younger than 16 years undergoing surgery for congenital cardiac lesions.
  
  
  METHODS
  None.
  
  
  RESULTS
  Urine samples were obtained before and at intervals after surgery. Acute kidney injury was defined according to pediatric Risk, Injury, Failure, Loss, and End-stage kidney disease criteria. The temporal pattern of both urine neutrophil gelatinase-associated lipocalin absolute concentration elevation and normalized to urine creatinine concentration was correlated with the development of acute kidney injury and other clinical outcomes. We evaluated the predictive ability of both urine neutrophil gelatinase-associated lipocalin and urine neutrophil gelatinase-associated lipocalin/creatinine by area under the curve, when added to a clinical predictive model. Data from 106 pediatric patients were analyzed. Acute kidney injury occurred in 42 patients (39.6%). Urine neutrophil gelatinase-associated lipocalin significantly increased in patients with acute kidney injury at 1, 3, and 15 hours postoperatively. Urine neutrophil gelatinase-associated lipocalin and urine neutrophil gelatinase-associated lipocalin/creatinine correlated with surgical variables and clinical outcomes. Acute kidney injury prediction improved when urine neutrophil gelatinase-associated lipocalin was added to a clinical model (area under the curve increased at 1 hr from 0.85 to 0.91 and at 3 hr to 0.92). Neither the urine neutrophil gelatinase-associated lipocalin nor the urine neutrophil gelatinase-associated lipocalin/creatinine values were significantly different between patients with prerenal and sustained acute kidney injury.
  
  
  CONCLUSIONS
  Urine neutrophil gelatinase-associated lipocalin is a predictive biomarker for acute kidney injury after pediatric cardiac surgery, and it may permit earlier intervention that improves outcome of acute kidney injury. Urine neutrophil gelatinase-associated lipocalin normalized to urine creatinine improves the prediction of acute kidney injury severity but offers no advantage in acute kidney injury diagnosis.
authors.affiliation: 1Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Madrid, Spain. 2Pediatric Intensive Care Unit, Albacete General University Hospital, Albacete, Spain. 3Biochemistry and Laboratory Service, Albacete General University Hospital, Albacete, Spain.
authors.forename: Andrés José
authors.initials: AJ
authors.lastname: Alcaraz
authors.forename: Maite Augusta
authors.initials: MA
authors.lastname: Gil-Ruiz
authors.forename: Ana
authors.initials: A
authors.lastname: Castillo
authors.forename: Jorge
authors.initials: J
authors.lastname: López
authors.forename: Carlos
authors.initials: C
authors.lastname: Romero
authors.forename: Sarah Nicole
authors.initials: SN
authors.lastname: Fernández
authors.forename: Angel
authors.initials: A
authors.lastname: Carrillo
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D015415:Biomarkers / Q000652:urine*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*; D013030:Spain
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins