title: Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients.
abstract: OBJECTIVE
  To determine the ability of urinary neutrophil gelatinase-associated lipocalin (uNGAL) to predict cardiac surgery-associated acute kidney injury (CSA-AKI), continuous renal replacement therapy (CRRT), mortality, and a composite outcome of major adverse kidney events at 365 days (MAKE365), and to investigate the influence of cardiopulmonary bypass (CPB) on NGAL release.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A single-center university hospital.
  
  
  METHODS
  A cohort of 288 adult cardiac surgery patients.
  
  
  METHODS
  uNGAL was measured at baseline, immediately after surgery, and on days 1 and 2 postoperatively. The authors used the recent Kidney Disease Improving Global Outcomes consensus criteria to define CSA-AKI.
  
  
  RESULTS
  CSA-AKI occurred in 36.1% of patients. uNGAL rapidly became significantly higher in patients who developed AKI, with peak value immediately after surgery (349.9 [76.6-1446.6] v 90.1 [20.8-328] ng/mg creatinine; p<0.001). No measure of uNGAL (peak, postsurgery, day 1 or 2 postsurgery) accurately predicted CSA-AKI, CRRT, mortality, or MAKE365. However, immediately after surgery, CPB induced greater uNGAL release compared with off-pump surgery (265.5 µmol/L [71-989.6] v 48.7 ng/mg creatinine [17-129.8]; p<0.001). Moreover, such early uNGAL release correlated with CPB duration (r = 0.505; p<0.001) but not with peak serum creatinine values on day 3 or 7 after surgery.
  
  
  CONCLUSIONS
  uNGAL had a limited predictive ability for CSA-AKI or other relevant clinical outcomes after cardiac surgery and appeared to be more closely related to the use and duration of CPB. Thus, its levels may represent the aggregate effect of an inflammatory response to CPB as well as a renal response to cardiac surgery and inflammation.
authors: Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia;; Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;. Electronic address: merchuki2000@yahoo.es.
authors: Mercedes
authors: M
authors: Garcia-Alvarez
authors: Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia;; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;
authors: Neil J
authors: NJ
authors: Glassford
authors: Department of Intensive Care Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
authors: Antoni J
authors: AJ
authors: Betbese
authors: Department of Biochemistry, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
authors: Jordi
authors: J
authors: Ordoñez
authors: Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
authors: Victoria
authors: V
authors: Baños
authors: Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
authors: Marta
authors: M
authors: Argilaga
authors: Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
authors: Alfonso
authors: A
authors: Martínez
authors: Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia;
authors: Satoshi
authors: S
authors: Suzuki
authors: Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia;
authors: Antoine G
authors: AG
authors: Schneider
authors: Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia;
authors: Glenn M
authors: GM
authors: Eastwood
authors: Department of Anesthesiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;
authors: M
authors: M
authors: Victoria Moral
authors: Department of Intensive Care Medicine, Austin Hospital, Melbourne, Australia;; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
authors: Rinaldo
authors: R
authors: Bellomo
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000652:urine*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000652:urine*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: acute kidney injury; biomarker; cardiac surgery; cardiopulmonary bypass; neutrophil gelatinase-associated lipocalin; urine NGAL