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Importance of neutrophil gelatinase-associated lipocalin and cystatin C in early diagnosis of cardiopulmonary bypass associated acute kidney injury in adult patients

Year 2019, Volume: 10 Issue: 2, 142 - 148, 12.06.2019

Okan Yıldız Selim Çapçı Ahmet Ünlü Baran Şimşek İlhan Paşaoğlu

https://doi.org/10.18663/tjcl.456033

Abstract

Aim: The development of acute kidney injury (AKI) after
cardiopulmonary bypass (CPB) is associated with increased rates of mortality
and morbidity. The identification of reliable biomarkers that allow earlier diagnosis
of AKI in the post-operative period may increase the success of therapeutic
interventions. The aim of our present study was to measure neutrophil
gelatinase-associated lipocalin (NGAL) and cystatin C
(Cys C) levels and to test the accuracy and reliability as an early biomarker.

Material and Methods: The study was designed as a prospective observational
study, comparing creatinine, NGAL, and Cys C levels in patients who develop AKI
or not after heart surgery using CPB. Forty-three patients met the inclusion
criteria. We obtained blood samples for NGAL and Cys C at two predetermined
time-points (6 and 24 hours) after the initiation of CPB. 

Results: According to the AKIN classification, 8 patients
(44%) developed AKI (AKI1 groups) and 35 (56%) did not (non-AKI). The areas
under the receiver operating characteristic curve (AUCROC) values were
calculated for all parameters. AUCROC value was 0.81 (95% CI: 0, 63
to 1, 00) for 6th hours NGAL and 0.867 (95% CI: 0, 00-1, 00, p:
0.004) for 24th Cys C. Therefore, NGAL measured in 6th
hours and 24th Cys C, have diagnostic value for early diagnosis of
acute kidney injury.







Conclusion: Based on our study, NGAL levels measured in 6th hour,
and Cys C levels measured in the 24th hour have high predictive value for early
diagnosis for CPB-ABH. 

Keywords

cardiopulmonary bypass acute kidney injury neutrophil gelatinase-associated lipocalin cystatin C

References

  • 1. Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int 2005; 67: 1112-19.
  • 2. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011; 114: 964-70.
  • 3. Erdoğan MB, Demirpençe Ö, Yıldırım M. Kardiyovasküler Cerrahi Sonrası Gelişen Akut Böbrek Yetmezliğinin Tanısında Kullanılan Erken Dönem Belirteçler. ACU Sağlık Bil Derg 2016:14-19
  • 4. Sudi-Ghonemy TA, Amro GM. Plasma neutrophil gelatinase-associated lipocalin (NGAL) and plasma cystatin C (CysC) as biomarker of acute kidney injury after cardiac surgery. Saudi J Kidney Dis Transpl 2014; 25: 582–88
  • 5. Mishra J, Dent C, Tarabishi R et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231-38.
  • 6. Dent CL, Ma Q, Dastrala S et al. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care 2007; 11: 127.
  • 7. Bennett M, Dent CL, Ma Q et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008; 3: 665-73.
  • 8. Soni SS, Pophale R, Ronco C. New biomarkers for acute renal injury. Clin Chem Lab Med 2011; 49: 1257-63.
  • 9. Haase M, Bellomo R, Devarajan P et al. Novel biomarkers early predict the severity of acute kidney injury after cardiac surgery in adults. Ann Thorac Surg 2009; 88: 124-30.
  • 10. Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000; 35: 117-31.
  • 11. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: 31.
  • 12. Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology 2010; 112: 1023-40.
  • 13. Lewington A, Kanagasundaram S. Renal Association Clinical Practice Guidelines on Acute Kidney Injury. Nephron Clinical Practice 2011; 118: 349-90.
  • 14. Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg 2011; 92: 1539-47.
  • 15. Uchino S, Bellomo R, Bagshaw SM, Goldsmith D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant 2010; 25: 1833-39.
  • 16. Wagener G, Jan M, Kim M et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 2006; 105: 485-91.
  • 17. Garwood S. Cardiac surgery-associated acute renal injury: new paradigms and innovative therapies. J Cardiothorac Vasc Anesth 2010; 24: 990-1001.
  • 18. Karadeniz Z, Tuncel Z, Yapıcı N et al. Akut Böbrek Hasarının Erken Tanısında Plazma NGAL (Neutrophil Gelatinase-Associated Lipocalin) Etkinliğinin Off-pump ve On-pump Kalp Cerrahisinde Karşılaştırılması. Göğüs-Kalp-Damar Anestezi ve Yoğun Bakım Derneği Dergisi 2013: 168-174
  • 19. Tuladhar SM, Puntmann VO, Soni M, Punjabi PP, Bogle RG. Rapid detection of acute kidney injury by plasma and urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass. J Cardiovasc Pharmacol 2009; 53: 261-66.
  • 20. Wagener G, Gubitosa G, Wang S, Borregaard N, Kim M, Lee HT. Urinary neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery. Am J Kidney Dis 2008; 52: 425-33.
  • 21. Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U. Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion 2002; 17: 401-406.
  • 22. Liangos O, Tighiouart H, Perianayagam MC et al. Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass. Biomarkers 2009; 14: 423-31
  • 23. McIlroy DR, Wagener G, Lee HT. Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. Clin J Am Soc Nephrol 2010; 5: 211-19.
  • 24. Dharnidharka VR, Kwon C,Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis Am J Kidney Dis 2002; 40: 221-26
  • 25. McIlroy DR, Wagener G, Lee HT. Biomarkers of acute kidney injury: an evolving domain. Anesthesiology 2010; 112: 998-1004.
  • 26 . Lameire NH, Vanholder RC, Van Biesen WA. How to use biomarkers efficiently in acute kidney injury. Kidney Int 2011; 79: 104

Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi

Year 2019, Volume: 10 Issue: 2, 142 - 148, 12.06.2019

Okan Yıldız Selim Çapçı Ahmet Ünlü Baran Şimşek İlhan Paşaoğlu

https://doi.org/10.18663/tjcl.456033

Abstract

Amaç:
Kardiyopulmoner bypass sonrası oluşan akut böbrek hasarı (CPB-ABH) mortalite ve
morbidite artışı ile ilişkilidir. Postoperatif dönemde ABH erken tanısını
sağlayacak biyobelirteçler tedavi başarısını artırabilir. Bu çalışmanın amacı neutrophil gelatinase-associated
lipocalin (NGAL) ve sistatin C (Cys C)
seviyelerini ölçmek ve erken biyobelirteç olarak doğruluk ve güvenilirliği test
etmektir.

Gereç
ve Yöntemler: Çalışmamız CPB kullanılarak uygulanan
kalp cerrahisi sonrası ABH gelişen hastalarda kreatinin, NGAL ve Cys C
düzeylerini karşılaştıran prospektif gözlemsel bir çalışmadır. Kırk üç hasta
çalışmaya dâhil edildi. CPB'nin başlatılmasından sonra, önceden belirlenmiş iki
zaman noktasında (6 ve 24 saat) NGAL ve Cys C için kan örnekleri alındı.

Bulgular:
AKIN sınıflamasına göre, 8 hasta (% 44) ABH gelişti, 35 (% 56) hastada ABH
gözlenmedi. Tüm parametreler için işletim karakteristiği eğrisi altında kalan
alan (AUCROC) hesaplandı. AUCROC değeri 6.saat NGAL için
0,81 (%95 CI:0,63-1,0 p=006) ve 24. Cys C. için 0,867 (95% CI: 0,00-1,00 p:
0,004) idi. Bu nedenle, 6. saat NGAL ve 24. saat Cys C değerleri ABH teşhisi
için tanısal değere sahiptir.







Sonuç:
Çalışmamıza göre, 6. saatte NGAL ve 24. saatte Cys C düzeyleri, CPB-ABH erken
teşhisi için güçlü bir tanısal değere sahiptir. 

Keywords

Kardiyopulmoner Bypass akut böbrek hasarı neutrophil gelatinase-associated lipocalin sistatin C

References

  • 1. Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int 2005; 67: 1112-19.
  • 2. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011; 114: 964-70.
  • 3. Erdoğan MB, Demirpençe Ö, Yıldırım M. Kardiyovasküler Cerrahi Sonrası Gelişen Akut Böbrek Yetmezliğinin Tanısında Kullanılan Erken Dönem Belirteçler. ACU Sağlık Bil Derg 2016:14-19
  • 4. Sudi-Ghonemy TA, Amro GM. Plasma neutrophil gelatinase-associated lipocalin (NGAL) and plasma cystatin C (CysC) as biomarker of acute kidney injury after cardiac surgery. Saudi J Kidney Dis Transpl 2014; 25: 582–88
  • 5. Mishra J, Dent C, Tarabishi R et al. Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231-38.
  • 6. Dent CL, Ma Q, Dastrala S et al. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care 2007; 11: 127.
  • 7. Bennett M, Dent CL, Ma Q et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008; 3: 665-73.
  • 8. Soni SS, Pophale R, Ronco C. New biomarkers for acute renal injury. Clin Chem Lab Med 2011; 49: 1257-63.
  • 9. Haase M, Bellomo R, Devarajan P et al. Novel biomarkers early predict the severity of acute kidney injury after cardiac surgery in adults. Ann Thorac Surg 2009; 88: 124-30.
  • 10. Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000; 35: 117-31.
  • 11. Mehta RL, Kellum JA, Shah SV et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: 31.
  • 12. Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology 2010; 112: 1023-40.
  • 13. Lewington A, Kanagasundaram S. Renal Association Clinical Practice Guidelines on Acute Kidney Injury. Nephron Clinical Practice 2011; 118: 349-90.
  • 14. Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A. Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg 2011; 92: 1539-47.
  • 15. Uchino S, Bellomo R, Bagshaw SM, Goldsmith D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant 2010; 25: 1833-39.
  • 16. Wagener G, Jan M, Kim M et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 2006; 105: 485-91.
  • 17. Garwood S. Cardiac surgery-associated acute renal injury: new paradigms and innovative therapies. J Cardiothorac Vasc Anesth 2010; 24: 990-1001.
  • 18. Karadeniz Z, Tuncel Z, Yapıcı N et al. Akut Böbrek Hasarının Erken Tanısında Plazma NGAL (Neutrophil Gelatinase-Associated Lipocalin) Etkinliğinin Off-pump ve On-pump Kalp Cerrahisinde Karşılaştırılması. Göğüs-Kalp-Damar Anestezi ve Yoğun Bakım Derneği Dergisi 2013: 168-174
  • 19. Tuladhar SM, Puntmann VO, Soni M, Punjabi PP, Bogle RG. Rapid detection of acute kidney injury by plasma and urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass. J Cardiovasc Pharmacol 2009; 53: 261-66.
  • 20. Wagener G, Gubitosa G, Wang S, Borregaard N, Kim M, Lee HT. Urinary neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery. Am J Kidney Dis 2008; 52: 425-33.
  • 21. Fischer UM, Weissenberger WK, Warters RD, Geissler HJ, Allen SJ, Mehlhorn U. Impact of cardiopulmonary bypass management on postcardiac surgery renal function. Perfusion 2002; 17: 401-406.
  • 22. Liangos O, Tighiouart H, Perianayagam MC et al. Comparative analysis of urinary biomarkers for early detection of acute kidney injury following cardiopulmonary bypass. Biomarkers 2009; 14: 423-31
  • 23. McIlroy DR, Wagener G, Lee HT. Neutrophil gelatinase-associated lipocalin and acute kidney injury after cardiac surgery: the effect of baseline renal function on diagnostic performance. Clin J Am Soc Nephrol 2010; 5: 211-19.
  • 24. Dharnidharka VR, Kwon C,Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis Am J Kidney Dis 2002; 40: 221-26
  • 25. McIlroy DR, Wagener G, Lee HT. Biomarkers of acute kidney injury: an evolving domain. Anesthesiology 2010; 112: 998-1004.
  • 26 . Lameire NH, Vanholder RC, Van Biesen WA. How to use biomarkers efficiently in acute kidney injury. Kidney Int 2011; 79: 104
There are 26 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Okan Yıldız 0000-0002-6192-3111

Selim Çapçı 0000-0002-9899-7704

Ahmet Ünlü This is me 0000-0002-8928-1421

Baran Şimşek 0000-0002-9554-9498

İlhan Paşaoğlu This is me 0000-0002-4756-3869

Publication Date June 12, 2019
Published in Issue Year 2019 Volume: 10 Issue: 2

Cite

APA Yıldız, O., Çapçı, S., Ünlü, A., Şimşek, B., et al. (2019). Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi. Turkish Journal of Clinics and Laboratory, 10(2), 142-148. https://doi.org/10.18663/tjcl.456033
AMA Yıldız O, Çapçı S, Ünlü A, Şimşek B, Paşaoğlu İ. Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi. TJCL. June 2019;10(2):142-148. doi:10.18663/tjcl.456033
Chicago Yıldız, Okan, Selim Çapçı, Ahmet Ünlü, Baran Şimşek, and İlhan Paşaoğlu. “Erişkin Hastalarda Kardiyopulmoner Bypass Sonrası gelişen Akut böbrek hasarının Erken tanısında Neutrophil Gelatinase-Associated Lipocalin Ve Sistatin C’nin önemi”. Turkish Journal of Clinics and Laboratory 10, no. 2 (June 2019): 142-48. https://doi.org/10.18663/tjcl.456033.
EndNote Yıldız O, Çapçı S, Ünlü A, Şimşek B, Paşaoğlu İ (June 1, 2019) Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi. Turkish Journal of Clinics and Laboratory 10 2 142–148.
IEEE O. Yıldız, S. Çapçı, A. Ünlü, B. Şimşek, and İ. Paşaoğlu, “Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi”, TJCL, vol. 10, no. 2, pp. 142–148, 2019, doi: 10.18663/tjcl.456033.
ISNAD Yıldız, Okan et al. “Erişkin Hastalarda Kardiyopulmoner Bypass Sonrası gelişen Akut böbrek hasarının Erken tanısında Neutrophil Gelatinase-Associated Lipocalin Ve Sistatin C’nin önemi”. Turkish Journal of Clinics and Laboratory 10/2 (June 2019), 142-148. https://doi.org/10.18663/tjcl.456033.
JAMA Yıldız O, Çapçı S, Ünlü A, Şimşek B, Paşaoğlu İ. Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi. TJCL. 2019;10:142–148.
MLA Yıldız, Okan et al. “Erişkin Hastalarda Kardiyopulmoner Bypass Sonrası gelişen Akut böbrek hasarının Erken tanısında Neutrophil Gelatinase-Associated Lipocalin Ve Sistatin C’nin önemi”. Turkish Journal of Clinics and Laboratory, vol. 10, no. 2, 2019, pp. 142-8, doi:10.18663/tjcl.456033.
Vancouver Yıldız O, Çapçı S, Ünlü A, Şimşek B, Paşaoğlu İ. Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi. TJCL. 2019;10(2):142-8.


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