title: Creatinine, Neutrophil Gelatinase-Associated Lipocalin, and Cystatin C in Determining Acute Kidney Injury After Heart Operations Using Cardiopulmonary Bypass.
abstract: Acute kidney injury (AKI) represents frequent complication after cardiac surgery using cardiopulmonary bypass (CPB). In the hope to enhance earlier more reliable characterization of AKI, we tested the utility of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in addition to standard creatinine for early determination of AKI after cardiac surgery using CPB. Forty-one patients met the inclusion criteria. Arterial blood samples collected after induction of general anesthesia were used as baseline, further sampling occurred at CPB termination, 2 h after CPB, on the first and second day after surgery. According to AKIN classification 18 patients (44%) developed AKI (AKI1-2 groups) and 23 (56%) did not (non-AKI group). Groups were similar regarding demographics and operative characteristics. CysC levels differed already preoperatively (non-AKI vs. AKI2; P = 0.045; AKI1 vs. AKI2; P = 0.011), while postoperatively AKI2 group differed on the first day and AKI1 on the second regarding non-AKI group (P = 0.004; P = 0.021, respectively). NGAL and creatinine showed significant difference already 2 h after CPB between groups AKI2 and non-AKI and later on the first postoperative day between groups AKI1 and AKI2 (P = 0.028; P = 0.014, respectively). This study shows similar performance of early plasma creatinine and NGAL in patients with preserved preoperative renal function. It demonstrates that creatinine, as well as NGAL, differentiate subsets of patients developing AKI of clinically more advanced grade early after 2 h, also when used single and uncombined.
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia.|Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Germany.
authors.forename: Jurij Matija
authors.initials: JM
authors.lastname: Kališnik
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia.
authors.forename: Eva
authors.initials: E
authors.lastname: Hrovat
authors.affiliation: Department of Anesthesiology, University Medical Center, Ljubljana.
authors.forename: Alenka
authors.initials: A
authors.lastname: Hrastovec
authors.affiliation: Faculty of Health Sciences, University of Ljubljana, Ljubljana.
authors.forename: Janez
authors.initials: J
authors.lastname: Žibert
authors.affiliation: Department of Clinical Chemistry and Biochemistry, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Aleš
authors.initials: A
authors.lastname: Jerin
authors.affiliation: Department of Clinical Chemistry and Biochemistry, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Milan
authors.initials: M
authors.lastname: Skitek
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Klokocovnik
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006801:Humans; D000071068:Lipocalin-2 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology
chemical_list: D015415:Biomarkers; D055316:Cystatin C; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D003404:Creatinine
keywords: -Acute kidney injury; -Cardiopulmonary bypass; -Cystatin C; Neutrophil gelatinase-associated lipocalin