title: The cardiac surgery-associated neutrophil gelatinase-associated lipocalin (CSA-NGAL) score: A potential tool to monitor acute tubular damage.
abstract: Acute kidney injury (AKI), defined as a rise in serum creatinine (functional AKI), is a frequent complication after cardiac surgery. The expression pattern of acute tubular damage biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) has been shown to precede functional AKI and, therefore, may be useful to identify very early tubular damage. The term subclinical AKI represents acute tubular damage in the absence of functional AKI (biomarker positivity without a rise in serum creatinine) and affects hard outcome measures. This potentiates an tubular-damage-based identification of renal injury, which may guide clinical management, allowing for very early preventive-protective strategies. The aim of this paper was to review the current available evidence on NGAL applicability in adult cardiac surgery patients and combine this knowledge with the expert consensus of the authors to generate an NGAL based tubular damage score: The cardiac surgery-associated NGAL Score (CSA-NGAL score). The CSA-NGAL score might be the tool needed to improve awareness and enable interventions to possibly modify these detrimental outcomes. In boldly doing so, it is intended to introduce a different approach in study designs, which will undoubtedly expand our knowledge and will hopefully move the AKI biomarker field forward.
authors.affiliation: Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: h.degeus@erasmusmc.nl.
authors.forename: Hilde R H
authors.initials: HR
authors.lastname: de Geus
authors.affiliation: Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
authors.affiliation: Department of Nephrology and Hypertension, Otto-von Guericke University, Magdeburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital Saint-Louis-Assistance-Publique Hôpitaux de Paris, Université Paris 7, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Jacob
authors.affiliation: Department of Renal Medicine St. James's University Hospital, Leeds, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lewington
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D000328:Adult; D000465:Algorithms; D015415:Biomarkers / Q000378:metabolism; D006348:Cardiac Surgical Procedures; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D006305:Health Status Indicators; D006801:Humans; D000071068:Lipocalin-2 / Q000378:metabolism*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2
keywords: AKI; CSA-NGAL score; ICU; NGAL; cardiac surgery; subclinical AKI