title: Usefulness of plasma neutrophil gelatinase-associated lipocalin as an early marker of acute kidney injury after cardiopulmonary bypass in Korean cardiac patients: a prospective observational study.
abstract: OBJECTIVE
  Development of acute kidney injury (AKI) after cardiopulmonary bypass (CPB) is relatively common and associated with increased mortality. Recently, plasma neutrophil gelatinase-associated lipocalin (NGAL) was used for the prediction of AKI. We evaluated the clinical usefulness of plasma NGAL.
  
  
  METHODS
  One hundred twelve adult patients undergoing cardiovascular surgery with CPB were included. Blood samples were obtained at baseline, at intensive care unit (ICU) admission, and 24h after ICU admission. The development of AKI, which is defined as an increase in serum creatinine by more than 50% within 3 postoperative days, was monitored. NGAL levels were analyzed by a Biosite Triage meter (Alere Medical, USA). Diagnostic performance of NGAL was analyzed using the area under the receiver operating characteristic curve.
  
  
  RESULTS
  In AKI patients (n=13), plasma NGAL levels at ICU admission were significantly higher than those at baseline [177 (122-402) vs. 121 (74-158) ng/mL, median (interquartile range), p=0.028], whereas serum creatinine showed no significant change. The predictive value of NGAL at ICU admission was 0.812 [95% confidence interval (CI), 0.68 to 0.95] with a cut-off value of 168.5ng/mL (sensitivity, 61.5%; specificity, 88.9%). After the exclusion of 35 patients with preoperative decreased renal function, the predictive value was increased to 0.911 (95% CI, 0.82 to 1.00).
  
  
  CONCLUSIONS
  This study showed that plasma NGAL may serve as a useful biomarker for the early detection of AKI in adult patients following CPB.
authors.affiliation: Department of Laboratory Medicine, Dongnam Institute of Radiology and Medical Sciences, Busan, South Korea.
authors.forename: Chul Min
authors.initials: CM
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Moon
authors.affiliation: Department of Special Chemistry, Green Cross Laboratories, Gyeonggi, South Korea.
authors.forename: Seungman
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Hanah
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Misuk
authors.initials: M
authors.lastname: Ji
authors.affiliation: Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea.
authors.forename: Mina
authors.initials: M
authors.lastname: Hur
authors.affiliation: Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, South Korea. Electronic address: ymyun@kuh.ac.kr.
authors.forename: Yeo-Min
authors.initials: YM
authors.lastname: Yun
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000209:etiology*; D000209:Acute-Phase Proteins; D000368:Aged; D044466:Asian People; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine
keywords: Acute kidney injury; Cardiopulmonary bypass; Early biomarker; Plasma NGAL