Key result
Early postoperative NGAL fails to correlate with AKI but is linked to infection and death.
Why the study?
The predictive value of urinary and serum NGAL early after non-cardiac major surgery for postoperative AKI, complications, and mortality was uncertain.
Does early postoperative measurement of urinary and serum NGAL predict acute kidney injury, complications, and mortality in patients undergoing non-cardiac major surgery?
Cohort (n=74)
Does early postoperative measurement of urinary and serum NGAL predict acute kidney injury, complications, and mortality in patients undergoing non-cardiac major surgery?
In patients undergoing major non-cardiac surgery, early postoperative NGAL levels predict postoperative infection and mortality, but not acute kidney injury.
NGAL should not guide postoperative AKI risk assessment; leaves open its association with infection and mortality for further study.
INTRODUCTION: We tested the hypothesis that urinary and serum neutrophil gelatinase-associated lipocalins (NGAL) early after non-cardiac major surgery predict postoperative acute kidney injury (AKI), complications and mortality. METHODS: We studied 74 patients undergoing orthopedic, vascular and abdominal surgery lasting ≥2 h. NGAL was measured in preoperative, as well as 2- and 6-hour postoperative samples. The primary outcome was AKI. Secondary outcome was postoperative infection and death. RESULTS: 10 patients (13.5%) developed AKI, 19 (26%) reached secondary outcomes, of whom 5 (7%) died. Serum NGAL was significantly higher in patients with diabetes and chronic kidney disease (CKD). No significant correlation was detected between serum or urine NGAL and subsequent development of AKI. Urine NGAL at 6 h and serum NGAL at 2 and 6 h were strongly correlated with postoperative infection and death (p = 0.004, p = 0.013 and p = 0.001, respectively). CONCLUSIONS: Our data suggest that in the general surgical population, NGAL could serve as a potent early biomarker for postoperative infection, and that the presence of CKD and diabetes mellitus is associated with higher levels of NGAL and may influence its predictive value.
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Shavit et al. (2011) conducted a cohort in Non-cardiac major surgery (n=74). Neutrophil gelatinase-associated lipocalin (NGAL) was evaluated on Acute kidney injury (AKI). Early postoperative NGAL levels did not significantly correlate with acute kidney injury (13.5% overall incidence), but correlated with postoperative infection and death (p=0.004, p=0.013, p=0.001).
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