Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

Se Jun Park; Hoseok Koo; Kyoung Jin Lee; Seo Hyun Kim; Seo Young Yun; Seunghyup Kim; Dong Hee Whang; Shin Young Joo; Byungmo Lee; HoJun Chin; Sihyung Park

doi:10.7180/kmj.2017.32.2.212

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Original Article Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery: Se Jun Park¹, Hoseok Koo¹, Kyoung Jin Lee¹, Seo Hyun Kim¹, Seo Young Yun¹, Seunghyup Kim¹, Dong Hee Whang², Shin Young Joo², Byungmo Lee³, HoJun Chin⁴, Sihyung Park⁵; Kosin Medical Journal 2017;32(2):212-220.
DOI: https://doi.org/10.7180/kmj.2017.32.2.212
Published online: January 19, 2017

¹Department of Internal Medicine, Inje University, Seoul Paik Hospital, Seoul, Korea

²Department of Clinical Pathology, Inje University, Seoul Paik Hospital, Seoul, Korea

³Department of Surgery, Inje University, Seoul Paik Hospital, Seoul, Korea

⁴Department of Internal Medicine, Seoul National university Bundang Hospital, Gyeonggido, Korea

⁵Department of Internal Medicine, Inje University, Haeundae Paik Hospital, Busan, Korea

Corresponding Author: Se Jun Park, Department of Internal Medicine, Inje University Seoul Paik Hospital, 9, Mareunnae-ro, Jung-gu, Seoul 04551, Korea. Tel: +82-2-2270-0015, Fax: +82-2-2270-0579, E-mail: sejun111@hanmail.net

• Received: February 13, 2016 • Accepted: May 23, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
References

Abstract

Objectives
The neutrophil gelatinase-associated lipocalin (NGAL) level following non cardiac surgery is useful for predicting acute kidney damage. However, there is insufficient conclusive evidence as to whether NGAL can be used to predict subclinical AKI following non-cardiac surgery.
Methods
We measured serum NGAL and creatinine levels in 41 patients following non-cardiac surgery, and the increase of these variables was used to predict acute decreases in kidney function.
Results
The study included a total of 41 patients. The mean age was 64.65 ± 17.09 years. The serum creatinine concentration was increased 12 hours after surgery. The mean SD serum NGAL decreased after 4hours after surgery and continued to decrease after 12 hours after surgery. The incidence of subclinical AKI determined by the 4 hour serum NGAL level was 10(24.4%), and the incidence of serum creatinine elevation was 0(0.0%). The incidence of subclinical AKI determined by the 12 hour serum NGAL level was 4(9.8%), and the incidence of subclinical AKI determined by serum creatinine was 4(9.8%). The elevation of NGAL was more rapid than the serum creatinine 4 hours after surgery
Conclusions
We verified the usefulness of the serum NGAL level as a predictive factor for subclinical AKI after non-cardiac surgery.
Keywords: Acute kidney injury; Creatinine; NGAL; Prognostic factor; Surgery

Fig. 1.

Change in serum NGAL and serum creatinine after the operations with mean and standard error. (A) Serum creatinine (B) NGAL, neutrophil geletinase-associated lipocalin.

Fig. 2.

Incidence of subclinical AKI with NGAL and AKI with serum creatinine after the OP. OP : operation; NGAL : neutrophil gelatinase-associated lipocalin; AKI : acute kidney injury; CV : coefficient of variation

Table 1.

Baseline characteristics of patients

Variable	Value (n = 41)
Age	64.65 ± 17.09
Sex (M:F), n(%)	27:14 (58.6:41.4)
BMI (kg/㎡)	24.77 ± 4.75
DM (Y:N), n(%)	14:27 (41.4:58.6)
Hypertension	22:19 (52.7:46.3)
BUN (mg/dL)	15.46 ± 11.34
Hemoglobin (g/dL)	11.34 ± 2.20
Hematocrit (%)	33.11 ± 5.98
Albumin (g/dL)	3.78 ± 0.47
Cholesterol (mg/dL)	167.10 ± 48.85
Na (mmol/L)	138.36 ± 2.71
K (mmol/L)	4.31 ± 0.56
Cl (mmol/L)	105.56 ± 3.54
Estimated GFR	53.61 ± 29.77
Urine Output 6 hrs before operation (ml)	633 ± 382
Duration of anesthesia (min)	111.46 ± 55.56
Duration of surgery (min)	139.51 ± 104.56
Anesthesia method
Epidural n(%)	1 (4.5)
Spinal n(%)	8 (36.4)
General n(%)	25 (40.9)
Local n(%)	7 (18.2)
Type of surgery
CSn(%)	2 (4.8)
GSn(%)	3 (7.3)
GYNn(%)	3 (7.3)
NSn(%)	1 (2.4)
OSn(%)	26 (63.4)
PSn(%)	1 (2.4)
UROn(%)	5 (12.1)

Values are presented as mean ± standard deviation and number (%).

BMI : body mass index, DM : diabetes mellitus, BUN : blood urea nitrogen, GFR : glomerular filtration rate

CS : cardiac surgery, GS : general surgery, GYN : gynecology, NS : neurosurgery, OS : orthopedic surgery

PS : plastic surgery, URO : urology

Table 2.

Serum NGAL, creatinine on 4, 12 hours after the operations and the incidence of subclinical acute kidney injury as judged by sesrum NGAL.

	Pre OP	Post OP 4 hr	Post OP 12 hr
NGAL (ng/mL)	268.48 ± 225.88	252.41 ± 212.53	231.82 ± 205.25
Creatinine (mg/dL)	1.55 ± 1.07	1.47 ± 1.07	1.53 ± 1.06
Subclinical AKI n(%)		10(24.4)	8(19.6)
AKI based on NGAL		10(24.4)	4(9.8)
AKI based on Cr		0(0.0)	4(9.8)

Values are presented as mean ± standard deviation and number (%).

OP : operation; NGAL : neutrophil gelatinase-associated lipocalin; AKI : acute kidney injury.

References

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Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

Kosin Med J. 2017;32(2):212-220. Published online January 19, 2017

DOI: https://doi.org/10.7180/kmj.2017.32.2.212

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Figure

Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

Fig. 1. Change in serum NGAL and serum creatinine after the operations with mean and standard error. (A) Serum creatinine (B) NGAL, neutrophil geletinase-associated lipocalin.

Fig. 2. Incidence of subclinical AKI with NGAL and AKI with serum creatinine after the OP. OP : operation; NGAL : neutrophil gelatinase-associated lipocalin; AKI : acute kidney injury; CV : coefficient of variation

Fig. 1.

Fig. 2.

Usefulness of neutrophil gelatinase-associated lipocalin(NGAL) to confirm subclinical acute kidney injury and renal prognosis in patients following surgery

Baseline characteristics of patients

Variable	Value (n = 41)
Age	64.65 ± 17.09
Sex (M:F), n(%)	27:14 (58.6:41.4)
BMI (kg/㎡)	24.77 ± 4.75
DM (Y:N), n(%)	14:27 (41.4:58.6)
Hypertension	22:19 (52.7:46.3)
BUN (mg/dL)	15.46 ± 11.34
Hemoglobin (g/dL)	11.34 ± 2.20
Hematocrit (%)	33.11 ± 5.98
Albumin (g/dL)	3.78 ± 0.47
Cholesterol (mg/dL)	167.10 ± 48.85
Na (mmol/L)	138.36 ± 2.71
K (mmol/L)	4.31 ± 0.56
Cl (mmol/L)	105.56 ± 3.54
Estimated GFR	53.61 ± 29.77
Urine Output 6 hrs before operation (ml)	633 ± 382
Duration of anesthesia (min)	111.46 ± 55.56
Duration of surgery (min)	139.51 ± 104.56
Anesthesia method
Epidural n(%)	1 (4.5)
Spinal n(%)	8 (36.4)
General n(%)	25 (40.9)
Local n(%)	7 (18.2)
Type of surgery
CSn(%)	2 (4.8)
GSn(%)	3 (7.3)
GYNn(%)	3 (7.3)
NSn(%)	1 (2.4)
OSn(%)	26 (63.4)
PSn(%)	1 (2.4)
UROn(%)	5 (12.1)

Serum NGAL, creatinine on 4, 12 hours after the operations and the incidence of subclinical acute kidney injury as judged by sesrum NGAL.

	Pre OP	Post OP 4 hr	Post OP 12 hr
NGAL (ng/mL)	268.48 ± 225.88	252.41 ± 212.53	231.82 ± 205.25
Creatinine (mg/dL)	1.55 ± 1.07	1.47 ± 1.07	1.53 ± 1.06
Subclinical AKI n(%)		10(24.4)	8(19.6)
AKI based on NGAL		10(24.4)	4(9.8)
AKI based on Cr		0(0.0)	4(9.8)

Table 1. Baseline characteristics of patients

Values are presented as mean ± standard deviation and number (%).

BMI : body mass index, DM : diabetes mellitus, BUN : blood urea nitrogen, GFR : glomerular filtration rate

CS : cardiac surgery, GS : general surgery, GYN : gynecology, NS : neurosurgery, OS : orthopedic surgery

PS : plastic surgery, URO : urology

Table 2. Serum NGAL, creatinine on 4, 12 hours after the operations and the incidence of subclinical acute kidney injury as judged by sesrum NGAL.

Values are presented as mean ± standard deviation and number (%).

OP : operation; NGAL : neutrophil gelatinase-associated lipocalin; AKI : acute kidney injury.