Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome

Serum levels of neutrophil Gelatinase associated Lipocalin (NGAL) predicts hemodialysis after coronary angiography in high risk patients with acute coronary syndrome

Contrast-induced nephropathy (CIN) following a percutaneous coronary intervention (PCI) is the third most common cause of acute kidney injury (AKI) worldwide. Patients who require hemodialysis secondary to CIN have an elevated mortality rate as high as 55%. The current definition of CIN is based on...

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Published in:BMC nephrology Vol. 21; no. 1; p. 143
Main Authors: Reyes, Luis F, Severiche-Bueno, Diego F, Bustamante, Carlos A, Murillo, Sixta, Soni, Nilam J, Poveda, Marcela, Gomez, Efraín, Buitrago, Ricardo, Rodriguez, Alejandro
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 22-04-2020
BioMed Central
BMC
Subjects:
Acute coronary syndromes
Angiography
Angioplasty
Biomarkers
Cellular proteins
Contrast agents
Contrast-induced nephropathy
Creatinine
Gelatinase
Health aspects
Heart failure
Hemodialysis
Identification and classification
Kidney diseases
Kidneys
Lipocalin
Mortality
Nephrology
Nephropathy
Neutrophils
Patient outcomes
Patients
Peritoneal dialysis
Physiological aspects
Risk groups
Serum levels
Spain
Biomarkers
Hemodialysis
Contrast-induced nephropathy
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Summary:Contrast-induced nephropathy (CIN) following a percutaneous coronary intervention (PCI) is the third most common cause of acute kidney injury (AKI) worldwide. Patients who require hemodialysis secondary to CIN have an elevated mortality rate as high as 55%. The current definition of CIN is based on an elevation of creatinine and decrease in urinary output. Creatinine typically increases 48 h after the contrast exposure, which delays the diagnosis and treatment of CIN. The neutrophil gelatinase associated lipocalin (NGAL) has emerged as a sensitive and specific biomarker of renal injury. Limited data exists about the effectiveness of NGAL to predict CIN in high-risk patients with acute coronary syndrome (ACS) that underwent PCI. The primary aim of this study was to determine the association of serum NGAL levels and the need for hemodialysis after PCI. This is a prospective, observational study. NGAL levels were measured using ELISA. Blood samples were obtained within the first 6 h of hospital admission, and 12 and 24 h after contrast exposure from angiography. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U test was used to test for differences in median serum levels of NGAL. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict the need for hemodialysis after PCI. A total of 2875 were screened; however, 45 patients with ACS that underwent PCI were included. All patients were at high risk of developing CIN defined by Mehran score > 11 points. The median (IQR) serum concentration of NGAL was significantly higher in patients that required versus did not require hemodialysis (340 [83-384] vs. 169 [100-210], p = 0.01). Elevated serum levels of NGAL with a cut-off at 6 h post PCI of 281 mg/dL predicted the need for hemodialysis with an area under the curve of 0.86 (95% CI, 0.66-1.00). In patients with ACS undergoing PCI; and high risk of developing CIN, an elevated serum level of NGAL 6 h after contrast exposure predicts the development of acute kidney injury requiring hemodialysis.
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ISSN:1471-2369
1471-2369
DOI:10.1186/s12882-020-01799-5