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Post cardiac surgery acute kidney injury: a woebegone status rejuvenated by the novel biomarkers.

Jayaraman R, Sunder S, Sathi S, Gupta VK, Sharma N, Kanchi P, Gupta A, Daksh SK, Ram P, Mohamed A - Nephrourol Mon (2014)

Bottom Line: It significantly increases morbidity and mortality.Novel urinary biomarkers are emerging which help in rapid diagnosis thus reducing the morbidity and mortality.Biomarkers of our study were neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 (IL-18).

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.

ABSTRACT

Background: Acute kidney injury (AKI) is common after cardiac surgery, the incidence varying between 7.7% and 28.1%. It significantly increases morbidity and mortality. Creatinine considerably delays the diagnosis with its own attended demerits. Novel urinary biomarkers are emerging which help in rapid diagnosis thus reducing the morbidity and mortality. Biomarkers of our study were neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 (IL-18).

Objectives: To find out the incidence of AKI in post-cardiac surgery patients in our hospital, the ability of the two biomarkers in early diagnosis in predicting the severity of AKI based on RIFLE's criteria and their ability to discriminate pre-renal from intrinsic AKI.

Patients and methods: One-hundred patients who underwent cardiac surgery were selected. Midstream urine samples were collected at 3 time intervals (baseline before surgery, 24 hours and 7 days after surgery). Biomarkers were measured by ELISA using BIORAD processors. Fractional excretion of sodium and urea were used to discriminate pre-renal from intrinsic AKI.

Results: Out of 100 patients, 31 had AKI, 11 being pre-renal and 20 intrinsic AKI. Four patients required renal replacement therapy (12.9% among AKI cases and 4% in the overall study cohort). Four among 31 expired in intensive care unit. Identifiable risk factors for AKI included insulin requiring diabetes mellitus, chronic obstructive pulmonary disease, increased cardio-pulmonary bypass time, combined valvular surgery and coronary artery bypass grafting, employment of intra-aortic balloon counter pulsation, left main coronary artery occlusion and an ejection fraction of < 40%. NGAL was extremely sensitive (area under curve-0.96) in detecting intrinsic AKI at 24 hours followed by IL-18 ratio with an area under curve of 0.89. Creatinine at 24 hours was able to detect only 31.6% of intrinsic AKI. None of the pre-renal cases showed rise in the urinary biomarker levels. Patients with higher stages of AKI had higher levels of both biomarkers than those at lower stages.

Conclusions: NGAL and IL-18 obviated the disadvantages of creatinine. They were efficient in early detection of AKI, in differentiating pre-renal from intrinsic AKI and in predicting the severity of AKI reliably in post-cardiac surgery patients.

No MeSH data available.


Related in: MedlinePlus

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fig11892: Algorithm Showing Overall Results and Outcomes in the Study

Mentions: Patients at increasing stages of AKI had increased biomarker levels than the patients at lower stages. A 24 hours NGAL level of > 200 pg/mL was a consistent finding in patients with “injury” stage of AKI, while a value of 375 pg/mL and 450 pg/mL was observed in those with “failure” and “loss” stages respectively. The highest observed value for NGAL at 24 hours was 520 pg/mL in “loss” stage of “RIFLE”. IL-18 produced also produced similar results with a value of > 350 pg/mL being observed in AKI beyond “INJURY” stage (Figure 4).


Post cardiac surgery acute kidney injury: a woebegone status rejuvenated by the novel biomarkers.

Jayaraman R, Sunder S, Sathi S, Gupta VK, Sharma N, Kanchi P, Gupta A, Daksh SK, Ram P, Mohamed A - Nephrourol Mon (2014)

Algorithm Showing Overall Results and Outcomes in the Study
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4109123&req=5

fig11892: Algorithm Showing Overall Results and Outcomes in the Study
Mentions: Patients at increasing stages of AKI had increased biomarker levels than the patients at lower stages. A 24 hours NGAL level of > 200 pg/mL was a consistent finding in patients with “injury” stage of AKI, while a value of 375 pg/mL and 450 pg/mL was observed in those with “failure” and “loss” stages respectively. The highest observed value for NGAL at 24 hours was 520 pg/mL in “loss” stage of “RIFLE”. IL-18 produced also produced similar results with a value of > 350 pg/mL being observed in AKI beyond “INJURY” stage (Figure 4).

Bottom Line: It significantly increases morbidity and mortality.Novel urinary biomarkers are emerging which help in rapid diagnosis thus reducing the morbidity and mortality.Biomarkers of our study were neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 (IL-18).

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology, Dr. Ram Manohar Lohia Hospital, Indraprastha University, New Delhi, India.

ABSTRACT

Background: Acute kidney injury (AKI) is common after cardiac surgery, the incidence varying between 7.7% and 28.1%. It significantly increases morbidity and mortality. Creatinine considerably delays the diagnosis with its own attended demerits. Novel urinary biomarkers are emerging which help in rapid diagnosis thus reducing the morbidity and mortality. Biomarkers of our study were neutrophil gelatinase-associated lipocalin (NGAL) and Interleukin-18 (IL-18).

Objectives: To find out the incidence of AKI in post-cardiac surgery patients in our hospital, the ability of the two biomarkers in early diagnosis in predicting the severity of AKI based on RIFLE's criteria and their ability to discriminate pre-renal from intrinsic AKI.

Patients and methods: One-hundred patients who underwent cardiac surgery were selected. Midstream urine samples were collected at 3 time intervals (baseline before surgery, 24 hours and 7 days after surgery). Biomarkers were measured by ELISA using BIORAD processors. Fractional excretion of sodium and urea were used to discriminate pre-renal from intrinsic AKI.

Results: Out of 100 patients, 31 had AKI, 11 being pre-renal and 20 intrinsic AKI. Four patients required renal replacement therapy (12.9% among AKI cases and 4% in the overall study cohort). Four among 31 expired in intensive care unit. Identifiable risk factors for AKI included insulin requiring diabetes mellitus, chronic obstructive pulmonary disease, increased cardio-pulmonary bypass time, combined valvular surgery and coronary artery bypass grafting, employment of intra-aortic balloon counter pulsation, left main coronary artery occlusion and an ejection fraction of < 40%. NGAL was extremely sensitive (area under curve-0.96) in detecting intrinsic AKI at 24 hours followed by IL-18 ratio with an area under curve of 0.89. Creatinine at 24 hours was able to detect only 31.6% of intrinsic AKI. None of the pre-renal cases showed rise in the urinary biomarker levels. Patients with higher stages of AKI had higher levels of both biomarkers than those at lower stages.

Conclusions: NGAL and IL-18 obviated the disadvantages of creatinine. They were efficient in early detection of AKI, in differentiating pre-renal from intrinsic AKI and in predicting the severity of AKI reliably in post-cardiac surgery patients.

No MeSH data available.


Related in: MedlinePlus