NGAL is Promising Biomarker of Kidney Injury After Heart Surgery

MedicalResearch.com Interview with:
Professeur Sidney Chocron

Chef de Service Chirurgie Thoracique et Cardio-Vasculaire
CHU de Besançon – Hôpital Jean Minjoz
BESANCON Cedex

Medical Research: What is the background for this study? What are the main findings?

Prof. Chocron: Acute kidney injury (AKI) is one of the most frequent complications after cardiac surgery.There is a time delay between the onset of renal impairment and the resulting telltale increase in blood creatinine levels.

Recent studies have underlined the promising properties of Neutrophil Gelatinase-Associated Lipocalin (NGAL). NGAL values early after surgery could predict the duration and severity of Acute Kidney Injury. In addition, NGAL can independently predict deteriorating renal function and could therefore be useful even in the context of pre-existing renal failure.

We aimed to assess the predictive ability of plasma NGAL levels to identify deteriorations in renal function after cardiac surgery in patients with pre-existing renal failure.

Medical Research: What are the main findings?

Prof. Chocron: One hundred sixty six patients with pre-operative renal failure i.e pre-operative creatinine clearance ≤60 mL/min/1.73m2 according to the Cockcroft Gault formula, were included in the study.

The threshold NGAL values at 6 hours after operation, as determined by ROC curve analysis was 155 ng/mL with a sensitivity of 79% and a specificity of 58%.

By multivariate analysis at 6 hours, a history of hypertension (OR=3.2 [1.2 – 8.9]), occurrence of at least 1 post-operative complication (OR=4.5 [1.3 – 15]), and an NGAL value above 155 ng/mL (OR=7.1 [2.7 – 18]) were shown to be independent predictors of the occurrence of post-operative AKI.

Medical Research: What should clinicians and patients take away from your report?

Prof. Chocron : The time gained in the diagnosis of Acute Kidney Injury by using the NGAL level at 6 hours instead of increase in blood creatinine level was on average 20 hours. Predicting the occurrence of post-operative Acute Kidney Injury early after the operation may be of clinical value, as it makes it possible to initiate treatment earlier.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Chocron: To assess that the time gained in the diagnosis of Acute Kidney Injury, and therefore the possibility to initiate treatment earlier, have an influence on the subsequent AKI either because AKI does not occur, or because renal damage is less severe.

Citation:

Neutrophil Gelatinase-Associated Lipocalin as Early Predictor of Acute Kidney Injury After Cardiac Surgery in Adults With Chronic Kidney Failure
Andrea Perrotti, MD Guillaume Miltgen, MD Albin Chevet-Noel, MD Camille Durst, MD Dewi Vernerey, MS Karine Bardonnet, MD Siamak Davani, MD, PhD Sidney Chocron, MD, PhDa,

The Annals of Thoracic Surgery Available online 13 January 2015