DOI: https://doi.org/10.22263/2312-4156.2021.2.45
Krachak D.I.1,2
Diagnostic value of biomarkers of acute kidney injury development after cardiac surgery performed in the conditions of cardiopulmonary bypass
1Republican Research Center «Cardiology», Minsk, Republic of Belarus
2Republican Clinical Medical Center of the Administrative Department of the President of the Republic of Belarus, Minsk, Republic of Belarus
Vestnik VGMU. 2021;20(2):45-55.
Abstract.
Objectives. To assess the diagnostic value of urinary lipocalin associated with neutrophil gelatinase (uNGAL) as a monomarker, as well as in combination with other indicators, in acute kidney injury (AKI) diagnosing in the early postoperative period in cardiac surgery patients.
Material and methods. The analysis of 73 case histories of ICU patients after cardiac surgery in the conditions of cardiopulmonary bypass was performed. AKIN criteria were applied to diagnose AKI. The primary end point of the study was the postoperative level of uNGAL, the secondary end point was the indexed value of uNGAL.
Results. 31 (42.4%) patients developed AKI (according to AKIN score). uNGAL had a very good level of diagnostic significance in detecting AKI (AUC 0.849, p=0.001) and its optimal cutoff level was more than 48.2 ng/ml within the time frame up to 12 hours after surgery. The diagnostic efficiency of the uNGAL test was: specificity ‒ 88.1%, sensitivity ‒ 67.74%, positive predictive value ‒ 80.8%, negative predictive value ‒ 78.7%, positive likelihood ratio ‒ 5.57, negative likelihood ratio ‒ 0.37. The ratio of uNGAL to leukocytes in the terms up to 12 hours after surgery demonstrated an excellent level of diagnostic value (AUC 0.920, p=0.001). The diagnostic efficiency of this indicator (more than 5.5 μg/1*109) was: specificity ‒ 94.74%, sensitivity ‒ 73.68%, positive predictive value ‒ 93.3%, negative predictive value ‒ 78.3%, positive likelihood ratio ‒ 14.0, negative likelihood ratio ‒ 0.28.
Conclusions. The diagnostic capabilities of uNGAL in detecting AKI in the early stages after cardiac surgery exceed the capabilities of serum creatinine traditionally used for this purpose. To improve the efficiency of AKI diagnosis in the early postoperative period, it is possible to use indexed indicators, for example, the ratio of uNGAL to leukocytes level in the patient’s blood.
Key words: acute kidney injury, cardiac surgery, cardiopulmonary bypass, urinary lipocalin-2, NGAL.
Acknowledgements: I express my deep gratitude to my scientific supervisor Doctor of Medical Sciences L.G. Shestakova (head of the department of extracorporeal circulation) for her valuable pieces of advice while preparing for and conducting scientific research. I am also thankful for the rendered assistance to the staff members of the cardiac surgery laboratory (headed by Professor, Doctor of Medical Sciences, Academician of the Belarusian Academy of Sciences Y.P. Ostrovskiy), of the clinicodiagnostic laboratory (headed by Candidate of Medical Sciences M.G. Kolyadko) and department of anesthesiology and resuscitation No.2 (headed by A.B.Valentyukevich) of the Republican Research Center «Cardiology».
Sources of research financing: The research «To develop and introduce into practice the technology of differentiated treatment for acute kidney failure in the early postoperative period based on the use of kidney injury markers in patients after cardiac transplantation and performing reconstructive surgical interventions on the heart» (№ GR 201 153 18) was conducted within the frames of the State Research Program (GPNI) «New technologies of diagnosing and treatment», subprogram «Transplantology and regenerative medicine».
References
1. Srisawat N, Kellum JA. The Role of Biomarkers in Acute Kidney Injury. Crit Care Clin. 2020 Jan;36(1):125-140. doi: http://dx.doi.org/10.1016/j.ccc.2019.08.010.
2. Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Roos C, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015 Aug;41(8):1411-23. doi: http://dx.doi.org/10.1007/s00134-015-3934-7
3. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005 Aug;294(7):813-8. doi: http://dx.doi.org/10.1001/jama.294.7.813
4. Tomilina NA, Podkorytova OL. Acute renal failure. Nefrologiia Dializ. 2009;11(1):4-20. (In Russ.)
5. Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004 Oct;66(4):1613-21. doi: http://dx.doi.org/10.1111/j.1523-1755.2004.00927.x
6. Cai L, Rubin J, Han W, Venge P, Xu S. The origin of multiple molecular forms in urine of HNL/NGAL. Clin J Am Soc Nephrol. 2010 Dec;5(12):2229-35. doi: http://dx.doi.org/10.2215/CJN.00980110
7. Castillo-Rodriguez E, Fernandez-Prado R, Martin-Cleary C, Pizarro-Sánchez MS, Sanchez-Niño MD, Sanz AB, et al. Kidney Injury Marker 1 and Neutrophil Gelatinase-Associated Lipocalin in Chronic Kidney Disease. Nephron. 2017;136(4):263-7. doi: http://dx.doi.org/10.1159/000447649
8. Colombo M, Looker HC, Farran B, Hess S, Groop L, Palmer CNA, et al. Serum kidney injury molecule 1 and β2-microglobulin perform as well as larger biomarker panels for prediction of rapid decline in renal function in type 2 diabetes. Diabetologia. 2019 Jan;62(1):156-168. doi: http://dx.doi.org/10.1007/s00125-018-4741-9
9. Jagadesan I, Agarwal I, Chaturvedi S, Jose A, Sahni RD, Fleming JJ. Urinary Neutrophil Gelatinase Associated Lipocalin - A Sensitive Marker for Urinary Tract Infection in Children. Indian J Nephrol. 2019 Sep-Oct;29(5):340-344. doi: http://dx.doi.org/10.4103/ijn.IJN_276_18
10. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012 Mar;2(1):1-38. doi: http://dx.doi.org/10.1038/kisup.2012.6
11. Abbott Laboratories. ARCHITECT Urine NGAL. Available from: https://www.ilexmedical.com/files/PDF/NGAL_ARC.pdf. [Accessed 08th Apr 2021].
12. Kallner A. Laboratory statistics: methods in chemistry and health science. 2nd ed. [S l]: Elsevier; 2018.
13. Waikar SS, Betensky RA, Bonventre JV. Creatinine as the gold standard for kidney injury biomarker studies? Nephrol Dial Transplant. 2009 Nov;24(11):3263-5. doi: http://dx.doi.org/10.1093/ndt/gfp428
14. Liu Y, Tan N, Zhou Y-L, Chen Y-Y, Chen J-Y, Chen J, et al. High-sensitivity C-reactive protein predicts contrast-induced nephropathy after primary percutaneous coronary intervention. J Nephrol. 2012 May-Jun;25(3):332-40. doi: http://dx.doi.org/10.5301/jn.5000007
15. Han SS, Kim DK, Kim S, Chin HJ, Chae D-W, Na KY. C-Reactive Protein Predicts Acute Kidney Injury and Death After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2017 Sep;104(3):804-810. doi: http://dx.doi.org/10.1016/j.athoracsur.2017.01.075
16. Schrier RW, Wang W, Poole B, Mitra A. Acute renal failure: definitions, diagnosis, pathogenesis, and therapy. J Clin Invest. 2004 Jul;114(1):5-14. doi: http://dx.doi.org/10.1172/JCI22353
17. Han SS, Ahn SY, Ryu J, Baek SH, Kim K-il, Chin HJ, et al. U-Shape Relationship of White Blood Cells with Acute Kidney Injury and Mortality in Critically Ill Patients. Tohoku J Exp Med. 2014 Mar;232(3):177-85. doi: http://dx.doi.org/10.1620/tjem.232.177
18. Soares S, Souza LCR, Cronin MT, Waaga-Gasser AM, Grossi MF, Franco GR, et al. Biomarkers and in vitro strategies for nephrotoxicity and renal disease assessment. Nephrol Renal Dis. 2020;5(1). doi: http://dx.doi.org/10.15761/NRD.1000162
Information about authors:
Krachak D.I. – cardiac surgeon, department of cardiac surgery, Republican Clinical Medical Center of the Administrative Department of the President of the Republic of Belarus,
ORCID: https://orcid.org/0000-0001-6770-4449
Correspondence address: Republic of Belarus, 220004, Minsk, 25-442 Zaslavskaya str. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Dmitriy I. Krachak.
