Shum HP, Leung NY, Chang LL, Tam OY, Kwan AM, Chan KC, Yan WW, Chan TM.: Nephrology (Carlton). 2015 Jan 20. doi: 10.1111/nep.12400. [Epub ahead of print]
PURPOSE: The performance of plasma Neutrophil gelatinase-associated lipocalin (pNGAL) for prediction of acute kidney injury (AKI) in non-cardiac surgical patients has not been well described. This study investigates the use of pNGAL for early detection of AKI in patients who were admitted to intensive care unit (ICU) after major or ultra-major non-cardiac surgery.
METHODS: 151 patients were recruited. Blood samples at time 0hr and 6hr post ICU admission were collected. Primary outcome was the occurrence of AKI within 48hr of ICU admission defined using Acute Kidney Injury Network (AKIN) classification.
RESULTS: Forty-five (29.8%) patients developed AKI within 48hr of ICU admission. Among them, 22, 14, and 9 were classified as AKIN Stage 1, 2, and 3 respectively. pNGAL level at 0hr and 6hr were significantly related to AKI severity. The areas under receiver operating characteristic curves (AUROC) for pNGAL at 0hr and 6hr increased with AKI severity (AKIN stage ≥1 0.671+/-0.048 & 0.691+/-0.047; stage ≥2 0.737+/-0.055 & 0.796+/-0.048; stage 3 0.829+/-0.072 & 0.860+/-0.065 respectively) and requirement of renal replacement therapy (0.880+/-0.059 & 0.837+/-0.088). Change of pNGAL from 0hr to 6hr showed no advantage in predictive power compared with pNGAL level at 0hr or 6hr alone. Addition of pNGAL into clinical AKI prediction model could only provide marginal benefit.
CONCLUSION: pNGAL correlated with severity of AKI and requirement of renal replacement therapy in ICU patients who received major or ultra-major non-cardiac surgery. However, the benefit of adding pNGAL into clinical AKI prediction model is marginal.