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

Year 2019, , 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. AUC_ROC value was 0.81 (95% CI: 0, 63
to 1, 00) for 6^th hours NGAL and 0.867 (95% CI: 0, 00-1, 00, p:
0.004) for 24^th Cys C. Therefore, NGAL measured in 6^th
hours and 24^th 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

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

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 (AUC_ROC) hesaplandı. AUC_ROC 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

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