None listed
Conditions
Brief summary
In surgical patients, outcome is strictly dependent on the occurrence of postoperative complication. Acute kidney injury (AKI) occurs in around 1% of noncardiac surgical patients and is commonly associated with more serious complications and poorer outcome (1). Serum creatinine is an insensitive marker for acute kidney injury and may not peak until several days after tubular insult (2). Neutrophil gelatinase-associated lipocalin (NGAL) is expressed by neutrophils, various epithelia as well as in the renal tubules (3). It is highly expressed in cells after infections, inflammation, ischemia or neoplastic transformation. Recent studies suggest that measurement of NGAL in patients at risk for cardiac surgery associated AKI can facilitate early diagnosis and implementation of therapeutic adjustment that decrease renal insult (4). However, the data on applications of plasma NGAL on predicting AKI in non-cardiac surgical patients is limited (5). The major objective of the study was to estimate the diagnostic accuracy of plasma NGAL on predicting subsequent development of AKI in non-cardiac postoperative patients that required intensive care. Additional objectives were to evaluate plasma NGAL as a biomarker for renal replacement therapy (RRT) use, intensive care unit (ICU) mortality and ICU length of stay. Workflow: 1. Eligible patients should fulfill all the inclusion criteria and without any exclusion criteria 2. Obtain consent from patient directly. For those with impaired consciousness due to underlying illness or use of sedatives, consent should be obtained from their close relatives. Clear explanation of the workflow should be performed with the use of the information sheet. 3. Plasma NGAL was taken within 1 hour and at 6th hour of post-operative ICU admission. 4. Blood samples were processed within 1 hour of collection using point of care test. 5. Primary and secondary outcomes were analysed subsequently based on medical records Reference: 1. Brienza N, Giglio MT, Marucci M. Preventing acute kidney injury after noncardiac surgery. Curr Opin Crit Care. 2010;16:353-358. 2. Bellomo R, Kellum JA, Ronco C. Defining acute renal failure: physiological principles. Intensive Care Med. 2004;30:33-37. 3. Kjeldsen L, Cowland JB, Borregaard N. Human neutrophil gelatinase-associated lipocalin and homologous proteins in rat and mouse. Biochim Biophys Acta. 2000;1482:272-283. 4. Cruz DN, Ronco C, Katz N. Neutrophil gelatinase-associated lipocalin: a promising biomarker for detecting cardiac surgery-associated acute kidney injury. J Thorac Cardiovasc Surg. 2010;139:1101-1106. 5. Shavit L, Dolgoker I, Ivgi H, Assous M, Slotki I. Neutrophil gelatinase-associated lipocalin as a predictor of complications and mortality in patients undergoing non-cardiac major surgery. Kidney Blood Press Res. 2011;34:116-124.
Interventions
The major objective of the study was to estimate the diagnostic accuracy of plasma NGAL on predicting subsequent development of acute kidney injury in non-cardiac postoperative patients that required intensive care. Plasma NGAL was taken within 1 hour and at 6th hour of post-operative ICU admission. Patients are observed until discharge from ICU to assess the presence of any acute kidney injury, requirement of renal support, ICU mortality
Sponsors
Shum Hoi Ping
Eligibility
Sex/Gender
All
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. All emergency and elective post non-cardiac operation patients that required ICU care 2. Expected ICU length of stay >24 hours
Exclusion criteria
1. Patients with chronic kidney disease stage 5 (Glomerular filtration rate estimated by Modification of Diet in Renal Disease (MDRD) equation of less than 15 ml/min) or those on renal replacement therapy 2. Surgical intervention that included nephrectomy 3. Cannot obtain consent from patients or their relatives
Outcome results
None listed