Urine neutrophil gelatinase\u2013associated lipocalin predicts outcome and renal failure in open and endovascular thoracic abdominal aortic aneurysm surgery

A Gombert,G Schälte,I Prior,A C Foldenauer,L Martin,G Marx,J Kalder,A Greiner,M J Jacobs,T Schürholz,J Grommes,M E Barbati

doi:10.1038/s41598-018-31183-1

Abstract

Urine neutrophil gelatinase–associated lipocalin (uNGAL) has been evaluated as a biomarker for AKI detection and adverse outcome in open and endovascular thoracoabdominal aortic aneurysm surgery. This observational, retrospective study included 52 patients. UNGAL was measured peri-operatively (48 h) and correlated with AKI requiring dialysis, tracheotomy and adverse outcome. Mean patients’ age was 64.5 years. A total of 26.9% (n = 14) developed AKI, and 21.1% (n = 11) required dialysis, tracheotomy rate was 19.2% (n = 10) and in-hospital mortality rate was 7.6% (n = 4). uNGAL levels were related to AKI requiring dialysis at ICU (p = 0.0002), need for tracheotomy at baseline and admission on ICU (p = 0.0222, p = 0.0028, respectively), as well as adverse discharge modality (p = 0.0051, p = 0.0048, respectively). Diagnostic quality was good for uNGAL levels at admission to ICU regarding AKI requiring dialysis (sensitivity: 81.8% [48.2–97.7]; specificity: 87.8% [73.8–95.9]; area under the curve (AUC): 0.874 [0.752–0.949]). The diagnostic quality of uNGAL was favorable for the prediction of tracheotomy (sensitivity: 70.0% [34.8–93.3]; specificity: 83.3% [68.6–93.0]; AUC: 0.807 [0.674–0.903]) and adverse discharge (sensitivity: 77.8% [40.0–97.2]; specificity: 83.7% [69.3–93.2]; AUC: 0.817 [0.685–0.910]). uNGAL may be valuable as an post-operative predictor of AKI and adverse outcome after open and endovascular TAAA repair.

Highlights

NGAL, a 25 kDa protein that binds covalently to neutrophil gelatinase, has been reported as a potential marker of angiogenesis and in particular as an early marker of AKI after cardiac and abdominal aortic surgery[13,14,15,16]
Patients were treated for thoracoabdominal aortic aneurysms (TAAAs) by open surgical 55.7% (n = 29) or endovascular 44.3% (n = 23) approach; 40.3% (n = 21) had type II TAAA, 4% (n = 2) type III, and 55.7% (n = 29) type IV (Table 1)
Investigating urine NGAL (uNGAL) at each time point, we identified a significant difference between patients with a favorable and an adverse discharge modality at all time points

Summary

Introduction

NGAL, a 25 kDa protein that binds covalently to neutrophil gelatinase, has been reported as a potential marker of angiogenesis and in particular as an early marker of AKI after cardiac and abdominal aortic surgery[13,14,15,16]. Levels of NGAL may be influenced by different factors such as systemic infection and inflammation[17]. NGAL is the most rapidly induced protein of nephrotoxic and ischemic AKI and is detectable 3 h following an initial kidney injury[21,22]. NGAL has been described as biomarker of adverse outcome in different cardiovascular settings[23,24]. We investigated the intriguing potential of urine NGAL (uNGAL) as a marker of AKI and adverse outcome in the context of complex endovascular and open TAAA surgery

Methods

Results

Conclusion