Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury aftecardiac surgery

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Abstract

Introduction: Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population. Materials and methods: Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea). Patients with at least two factors of AKI risk were selected and samples collected before the intervention and soon after the patient’s arrival in ICU. As reference standard, sCrea measurements and urine outputs were evaluated to define the clinical AKI. A Triage Meter for plasma NGAL fluorescence immunoassay was used. Results: Acute kidney injury occurred in 24 of the 69 patients (35%). Analysis of post-operative NGAL values demonstrated an AUC of 0.71, 95% CI (0.60-0.82) with a cut-off = 154 ng/mL (sensitivity = 76%, specificity = 59%). Moreover, NGAL after surgery had a good correlation with the AKI stage severity (P ≤ 0.001). Better diagnostic results were obtained with two consecutive tests: sensitivity 86% with a negative predictive value (NPV) of 87%. At 10-18 h after surgery sCrea measurement, as confirmatory test, allowed to reach a more sensitivity and specificity with a NPV of 96%. Conclusions: The assay results showed an improvement of NGAL diagnostic accuracy evaluating two tests. Consequently, NGAL may be useful for a timely treatment or for the AKI rule out in ICU patients.

Original languageEnglish
Article number030701
JournalBiochemia Medica
Volume28
Issue number3
DOIs
Publication statusPublished - Oct 1 2018

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Lipocalins
Gelatinases
Acute Kidney Injury
Surgery
Plasmas
Sensitivity and Specificity
Intensive care units
Creatinine
Intensive Care Units
Biomarkers
Thoracic Surgery
Serum
Lipocalin-2
Triage
Immunoassay
Assays
Area Under Curve
Fluorescence
Urine

Keywords

  • Acute kidney injury
  • AKI biomarkers
  • Cardiovascular surgery
  • Diagnostic accuracy
  • Neutrophil gelatinase-associated lipocalin

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

@article{76a2462562794e8582b827a603d96b1d,
title = "Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury aftecardiac surgery",
abstract = "Introduction: Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population. Materials and methods: Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea). Patients with at least two factors of AKI risk were selected and samples collected before the intervention and soon after the patient’s arrival in ICU. As reference standard, sCrea measurements and urine outputs were evaluated to define the clinical AKI. A Triage Meter for plasma NGAL fluorescence immunoassay was used. Results: Acute kidney injury occurred in 24 of the 69 patients (35{\%}). Analysis of post-operative NGAL values demonstrated an AUC of 0.71, 95{\%} CI (0.60-0.82) with a cut-off = 154 ng/mL (sensitivity = 76{\%}, specificity = 59{\%}). Moreover, NGAL after surgery had a good correlation with the AKI stage severity (P ≤ 0.001). Better diagnostic results were obtained with two consecutive tests: sensitivity 86{\%} with a negative predictive value (NPV) of 87{\%}. At 10-18 h after surgery sCrea measurement, as confirmatory test, allowed to reach a more sensitivity and specificity with a NPV of 96{\%}. Conclusions: The assay results showed an improvement of NGAL diagnostic accuracy evaluating two tests. Consequently, NGAL may be useful for a timely treatment or for the AKI rule out in ICU patients.",
keywords = "Acute kidney injury, AKI biomarkers, Cardiovascular surgery, Diagnostic accuracy, Neutrophil gelatinase-associated lipocalin",
author = "Giovanni Introcaso and Matteo Nafi and Alice Bonomi and Camilla L’acqua and Luca Salvi and Roberto Ceriani and Davide Carcione and Annalisa Cattaneo and Sandri, {Maria Teresa}",
year = "2018",
month = "10",
day = "1",
doi = "10.11613/BM.2018.030701",
language = "English",
volume = "28",
journal = "Biochemia Medica",
issn = "1330-0962",
publisher = "Biochemia Medica, Editorial Office",
number = "3",

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TY - JOUR

T1 - Improvement of neutrophil gelatinase-associated lipocalin sensitivity and specificity by two plasma measurements in predicting acute kidney injury aftecardiac surgery

AU - Introcaso, Giovanni

AU - Nafi, Matteo

AU - Bonomi, Alice

AU - L’acqua, Camilla

AU - Salvi, Luca

AU - Ceriani, Roberto

AU - Carcione, Davide

AU - Cattaneo, Annalisa

AU - Sandri, Maria Teresa

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Introduction: Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population. Materials and methods: Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea). Patients with at least two factors of AKI risk were selected and samples collected before the intervention and soon after the patient’s arrival in ICU. As reference standard, sCrea measurements and urine outputs were evaluated to define the clinical AKI. A Triage Meter for plasma NGAL fluorescence immunoassay was used. Results: Acute kidney injury occurred in 24 of the 69 patients (35%). Analysis of post-operative NGAL values demonstrated an AUC of 0.71, 95% CI (0.60-0.82) with a cut-off = 154 ng/mL (sensitivity = 76%, specificity = 59%). Moreover, NGAL after surgery had a good correlation with the AKI stage severity (P ≤ 0.001). Better diagnostic results were obtained with two consecutive tests: sensitivity 86% with a negative predictive value (NPV) of 87%. At 10-18 h after surgery sCrea measurement, as confirmatory test, allowed to reach a more sensitivity and specificity with a NPV of 96%. Conclusions: The assay results showed an improvement of NGAL diagnostic accuracy evaluating two tests. Consequently, NGAL may be useful for a timely treatment or for the AKI rule out in ICU patients.

AB - Introduction: Acute kidney injury (AKI) remains among the most severe complication after cardiac surgery. The aim of this study was to evaluate the neutrophil gelatinase-associated lipocalin (NGAL) as possible biomarker for the prediction of AKI in an adult cardiac population. Materials and methods: Sixty-nine consecutive patients who underwent cardiac surgeries in our hospital were prospectively evaluated. In the intensive care unit (ICU) NGAL was measured as a new biomarker of AKI besides serum creatinine (sCrea). Patients with at least two factors of AKI risk were selected and samples collected before the intervention and soon after the patient’s arrival in ICU. As reference standard, sCrea measurements and urine outputs were evaluated to define the clinical AKI. A Triage Meter for plasma NGAL fluorescence immunoassay was used. Results: Acute kidney injury occurred in 24 of the 69 patients (35%). Analysis of post-operative NGAL values demonstrated an AUC of 0.71, 95% CI (0.60-0.82) with a cut-off = 154 ng/mL (sensitivity = 76%, specificity = 59%). Moreover, NGAL after surgery had a good correlation with the AKI stage severity (P ≤ 0.001). Better diagnostic results were obtained with two consecutive tests: sensitivity 86% with a negative predictive value (NPV) of 87%. At 10-18 h after surgery sCrea measurement, as confirmatory test, allowed to reach a more sensitivity and specificity with a NPV of 96%. Conclusions: The assay results showed an improvement of NGAL diagnostic accuracy evaluating two tests. Consequently, NGAL may be useful for a timely treatment or for the AKI rule out in ICU patients.

KW - Acute kidney injury

KW - AKI biomarkers

KW - Cardiovascular surgery

KW - Diagnostic accuracy

KW - Neutrophil gelatinase-associated lipocalin

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U2 - 10.11613/BM.2018.030701

DO - 10.11613/BM.2018.030701

M3 - Article

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AN - SCOPUS:85055468990

VL - 28

JO - Biochemia Medica

JF - Biochemia Medica

SN - 1330-0962

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