TY - JOUR T1 - Erişkin hastalarda kardiyopulmoner bypass sonrası gelişen akut böbrek hasarının erken tanısında neutrophil gelatinase-associated lipocalin ve sistatin C’nin önemi TT - Importance of neutrophil gelatinase-associated lipocalin and cystatin C in early diagnosis of cardiopulmonary bypass associated acute kidney injury in adult patients AU - Yıldız, Okan AU - Çapçı, Selim AU - Ünlü, Ahmet AU - Şimşek, Baran AU - Paşaoğlu, İlhan PY - 2019 DA - June DO - 10.18663/tjcl.456033 JF - Turkish Journal of Clinics and Laboratory JO - TJCL PB - DNT Ortadoğu Yayıncılık A.Ş. WT - DergiPark SN - 2149-8296 SP - 142 EP - 148 VL - 10 IS - 2 LA - tr AB - Amaç:Kardiyopulmoner bypass sonrası oluşan akut böbrek hasarı (CPB-ABH) mortalite vemorbidite artışı ile ilişkilidir. Postoperatif dönemde ABH erken tanısınısağlayacak biyobelirteçler tedavi başarısını artırabilir. Bu çalışmanın amacı neutrophil gelatinase-associatedlipocalin (NGAL) ve sistatin C (Cys C)seviyelerini ölçmek ve erken biyobelirteç olarak doğruluk ve güvenilirliği testetmektir.Gereçve Yöntemler: Çalışmamız CPB kullanılarak uygulanankalp cerrahisi sonrası ABH gelişen hastalarda kreatinin, NGAL ve Cys Cdüzeylerini karşılaştıran prospektif gözlemsel bir çalışmadır. Kırk üç hastaçalışmaya dâhil edildi. CPB'nin başlatılmasından sonra, önceden belirlenmiş ikizaman 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 ABHgözlenmedi. Tüm parametreler için işletim karakteristiği eğrisi altında kalanalan (AUCROC) hesaplandı. AUCROC değeri 6.saat NGAL için0,81 (%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 teşhisiiçin tanısal değere sahiptir.Sonuç:Çalışmamıza göre, 6. saatte NGAL ve 24. saatte Cys C düzeyleri, CPB-ABH erkenteşhisi için güçlü bir tanısal değere sahiptir. KW - Kardiyopulmoner Bypass KW - akut böbrek hasarı KW - neutrophil gelatinase-associated lipocalin KW - sistatin C N2 - Aim: The development of acute kidney injury (AKI) aftercardiopulmonary bypass (CPB) is associated with increased rates of mortalityand morbidity. The identification of reliable biomarkers that allow earlier diagnosisof AKI in the post-operative period may increase the success of therapeuticinterventions. The aim of our present study was to measure neutrophilgelatinase-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 observationalstudy, comparing creatinine, NGAL, and Cys C levels in patients who develop AKIor not after heart surgery using CPB. Forty-three patients met the inclusioncriteria. We obtained blood samples for NGAL and Cys C at two predeterminedtime-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 areasunder the receiver operating characteristic curve (AUCROC) values werecalculated for all parameters. AUCROC value was 0.81 (95% CI: 0, 63to 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 6thhours and 24th Cys C, have diagnostic value for early diagnosis ofacute 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 earlydiagnosis for CPB-ABH. CR - 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. CR - 2. Kumar AB, Suneja M. Cardiopulmonary bypass-associated acute kidney injury. Anesthesiology 2011; 114: 964-70. CR - 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 CR - 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 CR - 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. CR - 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. CR - 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. CR - 8. Soni SS, Pophale R, Ronco C. New biomarkers for acute renal injury. Clin Chem Lab Med 2011; 49: 1257-63. CR - 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. CR - 10. Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000; 35: 117-31. CR - 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. CR - 12. Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology 2010; 112: 1023-40. CR - 13. Lewington A, Kanagasundaram S. Renal Association Clinical Practice Guidelines on Acute Kidney Injury. Nephron Clinical Practice 2011; 118: 349-90. CR - 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. CR - 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. CR - 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. CR - 17. Garwood S. Cardiac surgery-associated acute renal injury: new paradigms and innovative therapies. J Cardiothorac Vasc Anesth 2010; 24: 990-1001. CR - 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 CR - 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. CR - 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. CR - 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. CR - 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 CR - 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. CR - 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 CR - 25. McIlroy DR, Wagener G, Lee HT. Biomarkers of acute kidney injury: an evolving domain. Anesthesiology 2010; 112: 998-1004. CR - 26 . Lameire NH, Vanholder RC, Van Biesen WA. How to use biomarkers efficiently in acute kidney injury. Kidney Int 2011; 79: 104 UR - https://doi.org/10.18663/tjcl.456033 L1 - https://dergipark.org.tr/en/download/article-file/734857 ER -