Background: The risk for contrast-induced acute kidney injury (CI-AKI) following cardiac procedures involving contrast administration is particularly high among chronic kidney disease (CKD) patients. Neutrophil gelatinase-associated lipocain (NGAL) has been widely studied as an early marker for renal injury. However, CKD could impact NGAL levels and alter their predictive performance. This study aimed to evaluate a novel baseline “indexed NGAL” (I-NGAL), calculated by adjusting NGAL to the estimated glomerular filtration rate (eGFR), for the prediction of CI-AKI in CKD patients undergoing elective transcatheter aortic valve replacement (TAVR). Methods: A total of 134 CKD patients undergoing elective TAVR were included. Serum NGAL levels were drawn at hospital admission. Patients were followed for the occurrence of CI-AKI. Receiver-operator characteristic (ROC) methods were used to identify optimal sensitivity and specificity for I-NGAL. Univariate and multivariate binary logistic regression models were used to assess I-NGAL predictive performance. Results: Overall 35/134 patients (26%) developed CI-AKI following TAVR both NGAL and I-NGAL were significantly higher among patients having CI-AKI. I-NGAL results had a higher predictive ability than unindexed NGAL results (AUC of 0.83 vs. 0.78, p4 was also independently associated with CI-AKI (OR 8.13, 95% CI 3-21.8, p<0.001). Conclusion: Among CKD patients undergoing elective TAVR, adjusting baseline NGAL values according to eGFR yields an indexed NGAL that serves as an improved tool for predicting and ruling out CI-AKI, regardless of baseline renal function.
Khoury et al. (Tue,) studied this question.
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