Ann Lab Med.  2021 Jul;41(4):357-365. 10.3343/alm.2021.41.4.357.

Predictive Value of Plasma NGAL:Hepcidin-25 for Major Adverse Kidney Events After Cardiac Surgery with Cardiopulmonary Bypass: A Pilot Study

• Albert C
• Haase M
• Albert A
• Ernst M
• Kropf S
• Bellomo R
• Westphal S
• Braun-Dullaeus RC
• Haase-Fielitz A
• Elitok S

• KMID: 2512714
• DOI: http://doi.org/10.3343/alm.2021.41.4.357

Abstract

Background
Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin-25 are involved in catalytic iron-related kidney injury after cardiac surgery with cardiopulmonary bypass. We explored the predictive value of plasma NGAL, plasma hepcidin-25, and the plasma NGAL:hepcidin-25 ratio for major adverse kidney events (MAKE) after cardiac surgery.
Methods
We compared the predictive value of plasma NGAL, hepcidin-25, and plasma NGAL:hepcidin-25 with that of serum creatinine (Cr) and urinary output and protein for primary-endpoint MAKE (acute kidney injury [AKI] stages 2 and 3, persistent AKI > 48 hours, acute dialysis, and in-hospital mortality) and secondary-endpoint AKI in 100 cardiac surgery patients at intensive care unit (ICU) admission. We performed ROC curve, logistic regression, and reclassification analyses.
Results
At ICU admission, plasma NGAL, plasma NGAL:hepcidin-25, plasma interleukin-6, and Cr predicted MAKE (area under the ROC curve [AUC]: 0.77, 0.79, 0.74, and 0.74, respectively) and AKI (0.73, 0.89, 0.70, and 0.69). For AKI prediction, plasma NGAL:hepcidin-25 had a higher discriminatory power than Cr (AUC difference 0.26 [95% CI 0.00–0.53]). Urinary output and protein, plasma lactate, C-reactive protein, creatine kinase myocardial band, and brain natriuretic peptide did not predict MAKE or AKI (AUC < 0.70). Only plasma NGAL:hepcidin-25 correctly reclassified patients according to their MAKE and AKI status (category-free net reclassification improvement: 0.82 [95% CI 0.12–1.52], 1.03 [0.29–1.77]). After adjustment to the Cleveland risk score, plasma NGAL:hepcidin-25 ≥ 0.9 independently predicted MAKE (adjusted odds ratio 16.34 [95% CI 1.77–150.49], P = 0.014).
Conclusions
Plasma NGAL:hepcidin-25 is a promising marker for predicting postoperative MAKE.

Keyword

Acute kidney injury; Major adverse kidney events; Cardiac surgery; Cardiopulmonary bypass; Hepcidin; Neutrophil gelatinase-associated lipocalin; Serum creatinine

Figure

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  Fig. 1 AUCs of blood biomarkers at ICU admission to predict postoperative MAKE or AKI. Missing values: plasma NGAL (MAKE: N=1/9, no MAKE: N=2/91; AKI: N=2/9, no AKI: N=0/91), hepcidin-25 (MAKE: N=0/9, no MAKE: N=1/91; AKI: N=0/9, no AKI: N=1/91), plasma NGAL:hepcidin-25 (MAKE: N=1/9, no MAKE: N=2/91; AKI: N=2/9, no AKI: N=1/91). *Indicates biomarker with inverse relationship to endpoints. Abbreviations: AKI, acute kidney injury; AUC, area under the ROC curve; BNP, B-type natriuretic peptide; CK, creatine kinase; CKMB, creatine kinase myocardial band; CRP, C-reactive protein; ICU, intensive care unit; IL, interleukin; MAKE, major adverse kidney events; NGAL, neutrophil gelatinase-associated lipocalin.

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