Abstract

Acute kidney injury (AKI) is a serious complication in as much as half of the patients undergoing cardiac surgery, and early diagnosis and treatment are of the utmost importance. There is a need for robust biomarkers that can detect cardiac surgery-associated AKI (CSA-AKI) prior to rise in plasma creatinine, which typically occurs at least 48 h postoperatively. We compared pre- and 4, 12 and 48 h postoperative plasma (P) neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, urea and creatinine, and urine (U) NGAL, as markers of AKI, in 49 patients (67% men, median age 65 years) scheduled for elective cardiac surgery (e.g. coronary artery bypass graft and/or valve replacement surgery) with the use of extracorporeal circulation. Patients with preoperative sepsis, renal replacement therapy, or estimated glomerular filtration rate <30 mL/min/1.73m² were excluded. P- and U-NGAL were measured using the Roche Modular P (Roche Diagnostics^®) NGAL immunoassay. According to AKIN/KDIGO criteria, nine patients (18%) were diagnosed with CSA-AKI. Compared to patients without CSA-AKI, these patients had significantly higher P-NGAL and P-cystatin C values 4 h (p-values .002 and <.001) and 12 h (p-values <.001 and <.001) postoperatively. The same differences were not observed for U-NGAL. Patients with AKI also had significantly higher P-creatinine 4 and 12 h postoperatively (p-values .001 and <.001), however the rise in P-creatinine was just above the upper reference limit. In conclusion, plasma NGAL and cystatin C seem to detect CSA-AKI earlier than the more commonly used biomarkers creatinine and urea.

摘要

急性肾损伤（AKI）是多达一半的心脏手术患者的严重并发症，早期诊断和治疗至关重要。需要能够在血浆肌酐升高之前检测心脏手术相关 AKI (CSA-AKI) 的强大生物标志物，这通常发生在术后至少 48 小时。我们比较了 49 名患者（67%男性，中位年龄 65 岁）计划使用体外循环进行选择性心脏手术（例如冠状动脉旁路移植术和/或瓣膜置换手术）。术前脓毒症、肾脏替代治疗或估计肾小球滤过率<²被排除在外。P-和 U-NGAL 使用 Roche Modular P (Roche Diagnostics ^® ) NGAL 免疫测定法测量。根据 AKIN/KDIGO 标准，9 名患者 (18%) 被诊断为 CSA-AKI。与没有 CSA-AKI 的患者相比，这些患者在 4 小时（ p值.002 和 <.001）和 12 小时（p值<.001 和 <.001）时 P-NGAL 和 P-胱抑素 C 值显着升高术后。U-NGAL 没有观察到相同的差异。AKI 患者术后 4 和 12 小时 P-肌酐显着升高（p-值 .001 和 <.001)，但 P-肌酐的升高刚好高于参考上限。总之，血浆 NGAL 和胱抑素 C 似乎比更常用的生物标志物肌酐和尿素更早地检测到 CSA-AKI。