Pulse wave velocity and neutrophil gelatinase-associated lipocalin as predictors of acute kidney injury following aortic valve replacement

Journal of Cardiothoracic Surgery

Thanos Athanasiou³  Darrel P Francis¹  Jon Anderson³  Andrew Chukwuemeka³  Hatam Naase³  Hutan Ashrafian²  Leanne Harling³  Emaddin Kidher³ 

[1] International Centre for Circulatory Health, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK;The Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, 10th Floor, QEQM Wing, St Mary’s Hospital, Praed Street, London W2 1NY, UK;Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK

关键词: AVR;    Aortic valve replacement;    AKI;    Acute kidney injury;    NGAL;    Neutrophil gelatinase-associated lipocalin;    PWV;    Aortic stiffness;    Pulse wave velocity;   

Others  :  804762
DOI  :  10.1186/1749-8090-9-89

 received in 2014-03-28, accepted in 2014-05-12,  发布年份 2014

【 摘 要 】

Background

Accurate prediction, early detection and treatment of acute kidney injury (AKI) are essential for improving post-operative outcomes. This study aimed to examine the role of aortic stiffness and neutrophil gelatinase-associated lipocalin (NGAL) as predictors of AKI or need for early medical renal intervention following aortic valve replacement (AVR).

Methods

Aortic pulse wave velocity and plasma NGAL were measured pre-operatively in recruited patients undergoing AVR for aortic stenosis (AS). Plasma NGAL was also measured at 3 and 18–24 hours after cardiopulmonary bypass (CPB). AKI was defined using RIFLE criteria. Early medical renal intervention included diuretics or dopamine infusion exclusively for renal causes.

Results

Fifty-three patients aged 71 ± 9 years were included. Sixteen (30%) developed AKI (AKI-Yes) and 24 patients (45%) received early medical intervention (Intervention-Yes). There was no significant difference in the demographic, clinical or operative characteristics between the two groups for either outcome. PWV did not significantly correlate with AKI (r = 0.12, P = 0.13) or early intervention (r = 0.18, P = 0.18). At 3 h post-CPB, plasma NGAL was a much stronger predictor of both AKI and the need for early medical intervention than conventional markers such as creatinine (AKI: AUC 83%, 95% CI 0.70–0.95 vs. AUC 65%, 95% CI 0.47- 0.82; Medical intervention: AUC 84%, 95% CI 0.72–0.96 vs. AUC 56%, 95% CI 0.38–0.73). Post-CPB (3 hr) plasma NGAL was also significantly associated with AKI (r = 0.68, P < 0.001) at levels above 150 ng/ml; and significantly associated with early intervention (r = 0.64, P < 0.001) above 136 ng/ml. Simple linear regression showed no relationship between PWV and NGAL levels.

Conclusion

Aortic PWV does not correlate significantly with post-operative AKI or plasma NGAL levels in surgical AS patients. Post-operative NGAL is however an early and powerful predictive biomarker of both post-operative AKI and the need for early medical renal intervention and should consequently be considered in prediction models for AKI after cardiac surgery.

【 授权许可】

   
2014 Kidher et al.; licensee BioMed Central Ltd.

【 图 表 】

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