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Postoperative Neutrophil Gelatinase–Associated Lipocalin Predicts Acute Kidney Injury After Pediatric Cardiac Surgery*

Alcaraz, Andrés José PhD1; Gil-Ruiz, Maite Augusta MD, PhD1; Castillo, Ana MD2; López, Jorge MD1; Romero, Carlos MD3; Fernández, Sarah Nicole MD1; Carrillo, Ángel PhD1

Pediatric Critical Care Medicine: February 2014 - Volume 15 - Issue 2 - p 121–130
doi: 10.1097/PCC.0000000000000034
Cardiac Intensive Care

Objective: We investigated the temporal pattern and predictive value of neutrophil gelatinase–associated lipocalin for early identification of acute kidney injury in children undergoing cardiac surgery.

Design: Prospective observational cohort study.

Setting: One PICU in a tertiary medical center in Madrid, Spain.

Patients: One hundred six children older than 15 days and younger than 16 years undergoing surgery for congenital cardiac lesions.

Interventions: None.

Measurements and Main Results: Urine samples were obtained before and at intervals after surgery. Acute kidney injury was defined according to pediatric Risk, Injury, Failure, Loss, and End-stage kidney disease criteria. The temporal pattern of both urine neutrophil gelatinase–associated lipocalin absolute concentration elevation and normalized to urine creatinine concentration was correlated with the development of acute kidney injury and other clinical outcomes. We evaluated the predictive ability of both urine neutrophil gelatinase–associated lipocalin and urine neutrophil gelatinase–associated lipocalin/creatinine by area under the curve, when added to a clinical predictive model. Data from 106 pediatric patients were analyzed. Acute kidney injury occurred in 42 patients (39.6%). Urine neutrophil gelatinase–associated lipocalin significantly increased in patients with acute kidney injury at 1, 3, and 15 hours postoperatively. Urine neutrophil gelatinase–associated lipocalin and urine neutrophil gelatinase–associated lipocalin/creatinine correlated with surgical variables and clinical outcomes. Acute kidney injury prediction improved when urine neutrophil gelatinase–associated lipocalin was added to a clinical model (area under the curve increased at 1 hr from 0.85 to 0.91 and at 3 hr to 0.92). Neither the urine neutrophil gelatinase–associated lipocalin nor the urine neutrophil gelatinase–associated lipocalin/creatinine values were significantly different between patients with prerenal and sustained acute kidney injury.

Conclusions: Urine neutrophil gelatinase–associated lipocalin is a predictive biomarker for acute kidney injury after pediatric cardiac surgery, and it may permit earlier intervention that improves outcome of acute kidney injury. Urine neutrophil gelatinase–associated lipocalin normalized to urine creatinine improves the prediction of acute kidney injury severity but offers no advantage in acute kidney injury diagnosis.

1Pediatric Intensive Care Unit, Gregorio Marañón General University Hospital, Madrid, Spain.

2Pediatric Intensive Care Unit, Albacete General University Hospital, Albacete, Spain.

3Biochemistry and Laboratory Service, Albacete General University Hospital, Albacete, Spain.

* See also p. 173.

The authors disclosed that they do not have any potential conflicts of interest.

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©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies