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

Title: Pulse wave velocity and neutrophil gelatinase-associated lipocalin as predictors of acute kidney injury following aortic valve replacement
Authors: Kidher, E
Harling, L
Ashrafian, H
Naase, H
Chukwuemeka, A
Anderson, J
Francis, DP
Athanasiou, T
Item Type: Journal Article
Abstract: 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.
Issue Date: 17-May-2014
Date of Acceptance: 12-May-2014
URI: http://hdl.handle.net/10044/1/53999
DOI: https://dx.doi.org/10.1186/1749-8090-9-89
ISSN: 1749-8090
Publisher: BioMed Central
Journal / Book Title: Journal of Cardiothoracic Surgery
Volume: 9
Copyright Statement: © 2014 Kidher et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: FS/10/38/28268
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
CARDIAC & CARDIOVASCULAR SYSTEMS
Pulse wave velocity
Aortic stiffness
PWV
Neutrophil gelatinase-associated lipocalin
NGAL
Acute kidney injury
AKI
Aortic valve replacement
AVR
ACUTE-RENAL-FAILURE
GLOMERULAR-FILTRATION-RATE
ADULT CARDIAC-SURGERY
ARTERIAL STIFFNESS
PROSPECTIVE COHORT
SERUM BIOMARKERS
RISK-FACTORS
URINARY
MULTICENTER
Acute Kidney Injury
Acute-Phase Proteins
Aged
Aorta, Thoracic
Aortic Valve Stenosis
Biomarkers
Blood Flow Velocity
Early Diagnosis
Female
Heart Valve Prosthesis Implantation
Humans
Lipocalin-2
Lipocalins
Male
Postoperative Period
Predictive Value of Tests
Prognosis
Proto-Oncogene Proteins
Pulse Wave Analysis
ROC Curve
Retrospective Studies
1103 Clinical Sciences
Respiratory System
Publication Status: Published
Article Number: ARTN 89
Appears in Collections:Department of Surgery and Cancer