scholarly journals Plasma Neutrophil Gelatinase-Associated Lipocalin Reflects Both Inflammation and Kidney Function in Patients with Myocardial Infarction

2016 ◽  
Vol 6 (3) ◽  
pp. 180-190 ◽  
Author(s):  
Søren Lindberg ◽  
Jan S. Jensen ◽  
Søren Hoffmann ◽  
Allan Z. Iversen ◽  
Sune H. Pedersen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kidney Function ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Cross Sectional ◽  
Blood Samples ◽  
St Segment Elevation ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Neutrophil Gelatinase

Background/Aims: Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a marker for acute kidney injury and cardiovascular outcome. However, the relative importance of inflammation versus kidney function on plasma NGAL levels is uncertain, making the interpretation of plasma NGAL unclear. Accordingly, we investigated the relationship between plasma NGAL, inflammation and kidney function in patients with myocardial infarction (MI). Methods: We prospectively included 584 patients with acute ST-segment elevation MI (STEMI) treated with primary percutaneous coronary intervention (PCI) from 2006 to 2008. Blood samples were drawn immediately before PCI. Additionally, we included 42 patients who had 4 blood samples drawn before and after PCI. Plasma NGAL was measured using a time-resolved immunofluorometric assay. Cross-sectional analyses were performed in these two single-center, prospective study cohorts. Results: Estimated glomerular filtration rate (eGFR) was associated significantly more strongly with plasma NGAL when eGFR was abnormal compared to normal eGFR: a decrease in eGFR of 10 ml/min was associated with an increase in NGAL of 27% (18-36%) versus 4% (1-7%), respectively (p < 0.001). Leukocyte count and C-reactive protein were the main determinants of plasma NGAL in patients with normal eGFR, whereas eGFR was the main determinant at reduced kidney function. Conclusions: eGFR determines the association of NGAL with either inflammation or kidney function; in patients with normal eGFR, plasma NGAL reflects inflammation but when eGFR is reduced, plasma NGAL reflects kidney function, highlighting the dual perception of plasma NGAL. From a clinical perspective, eGFR may be used to guide the interpretation of elevated NGAL levels in patients with STEMI.

Neutrophil Gelatinase-Associated Lipocalin for the Early Prediction of Acute Kidney Injury in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 10 (3) ◽  
pp. 154-161
Author(s):  
Ilan Merdler ◽  
Keren-Lee Rozenfeld ◽  
David Zahler ◽  
Moshe Shtark ◽  
Ilana Goldiner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Sensitivity And Specificity ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Tubular Damage ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Renal Tubular ◽  
Neutrophil Gelatinase

Introduction and Objective: Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein released by renal tubular cells, can be used as a marker of early tubular damage. We evaluated plasma NGAL level utilization for the identification of acute kidney injury (AKI) among ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). Methods: 131 STEMI patients treated with PCI were prospectively included. Plasma NGAL levels were drawn prior to PCI (0 h) and 24 h afterwards. AKI was defined per KDIGO criteria of serum creatinine increase. Receiver-operating characteristic (ROC) methods were used to identify optimal sensitivity and specificity for the observed NGAL range. Results: Overall AKI incidence was 14%. NGAL levels were significantly higher for patients with AKI at both 0 h (164 ± 42 vs. 95 ± 30; p < 0.001) and 24 h (142 ± 41 vs. 93 ± 36; p < 0.001). Per ROC curve analysis, an optimal cutoff value of NGAL (>120 ng/mL) predicted AKI with 80% sensitivity and specificity (AUC 0.881, 95%, CI 0.801–0.961, p < 0.001). In a multivariate logistic regression model, NGAL levels were independently associated with AKI at 0 h (OR 1.044, 95% CI 1.013–1.076; p = 0.005) and 24 h (OR 1.018, 95% CI 1.001–1.036; p = 0.04). Conclusions: Elevated NGAL levels, suggesting renal tubular damage, are independently associated with AKI in STEMI patients undergoing primary PCI.

scholarly journals Detection of Renal Injury Following Primary Coronary Intervention among ST-Segment Elevation Myocardial Infarction Patients: Doubling the Incidence Using Neutrophil Gelatinase-Associated Lipocalin as a Renal Biomarker

2021 ◽  
Vol 10 (10) ◽  
pp. 2120
Author(s):  
Lior Lupu ◽  
Keren-Lee Rozenfeld ◽  
David Zahler ◽  
Samuel Morgan ◽  
Ilan Merdler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Tubular Damage ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background: A subgroup of patients with acute kidney injury (AKI) do not fulfil the functional criteria for AKI diagnosis but show elevated levels of new biomarkers reflecting tubular injury, suggesting that these patients suffer “subclinical AKI”. We investigated the incidence and possible implications of “subclinical AKI”, compared to no and clinical AKI among ST elevation myocardial infarction patients (STEMI) treated with primary coronary intervention (PCI). Methods: We included 223 patients with STEMI treated with PCI. Neutrophil gelatinase-associated lipocalin (NGAL) was used as a marker of renal tubular damage in the absence of functional AKI, with NGAL levels ≥100 ng/mL suggesting subclinical AKI. Patients were assessed for the occurrence of in-hospital adverse outcomes. Results: Of the study patients, 45 (25%) had subclinical AKI. These patients were more likely to have left ventricular ejection fraction ≤45% (33% vs. 23%. p = 0.01), in-hospital adverse outcomes (73% vs. 48%; p = 0.005), and a combination of the two. The multivariate regression model demonstrated that subclinical AKI was independently associated with in-hospital adverse outcomes (OR 3.71, 95% CI 1.30–10.62, p = 0.02). Conclusions: Subclinical AKI is common among STEMI patients and is independently associated with adverse outcomes, even in the absence of functional AKI.

scholarly journals Comparison of urine neutrophil gelatinase-associated lipocalin to serum creatinine to assess kidney function in neonatal asphyxia

2017 ◽  
Vol 56 (6) ◽  
pp. 356 ◽  
Author(s):  
Winston Leonardo Tanzil ◽  
Rocky Wilar ◽  
Max Frans Josef Mantik ◽  
Adrian Umboh ◽  
Suryadi Nicolaas Napoleon Tatura
Keyword(s):  
Serum Creatinine ◽  
Kidney Function ◽  
Predictive Value ◽  
Kidney Tissue ◽  
Kidney Injury ◽  
Urinary Ngal ◽  
Cross Sectional ◽  
Neonatal Asphyxia ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background Infants with neonatal asphyxia have multiorgan damage, such as to the kidneys (50%), central nervous system (28%), cardiovascular system (25%), and lungs (23%). Neonatal asphyxia reduces kidney perfusion, often leading to acute kidney injury (AKI) after asphyxia. Neutrophil gelatinase-associated lipocalin (NGAL) levels in the blood, urine and kidney tissue increased rapidly in AKI. Urinary NGAL is proposed to have better performance in diagnosing AKI than creatinine due to its earlier, rapid level increase and it is less invasive.Objective To compare urinary NGAL to serum creatinine as a marker to assess kidney function in neonatal asphyxia.Methods Diagnostic comparison study with cross-sectional design was performed at neonatal intensive care unit (NICU) of Prof. Dr. R. D. Kandou Hospital, Manado from November 2015 to February 2016. All subjects had neonatal asphyxia. Data were analyzed using descriptive analysis, receiver-operator characteristic (ROC) curve, and Z-test.Results Urinary NGAL with cut-off point of 652.24 ng/mL can predict AKI in neonates with asphyxia with 100% sensitivity, 75% specificity, 52.3% positive predictive value, and 100% negative predictive value. Chi-square test resulted in a value of x2 = 20.036, P=0.0001).This shows that urinary NGAL levels >652,24 ng/mL can predicts AKI by 20 times in infants with neonatal asphyxia. So, urinary NGAL performs better than serum creatinine, therefore it can replace serum creatinine as an alternative non-invasive diagnostic test for diagnosing AKI in infants with neonatal asphyxia.Conclusion The diagnostic value of urinary NGAL is higher than that of serum creatinine in assessing kidney function in neonatal asphyxia. 

Neutrophil Gelatinase-Associated Lipocalin for the Assessment of Reversible versus Persistent Renal Tubular Damage in ST-Segment Myocardial Infarction Patients

2021 ◽  
Vol 50 (6) ◽  
pp. 925-930
Author(s):  
Ariel Banai ◽  
Keren-Lee Rozenfeld ◽  
Itamar Loewenstein ◽  
David Zahler ◽  
Moshe Shtark ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Tubular Damage ◽  
Symptom Duration ◽  
Tubular Injury ◽  
Renal Tubular Damage ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Renal Tubular ◽  
Neutrophil Gelatinase

<b><i>Background:</i></b> Most studies investigated the value of neutrophil gelatinase-associated lipocalin (NGAL) as a marker of renal tubular injury only at a single time point. We investigated the possible utilization of NGAL level dynamics for the identification of different renal injury patterns in ST-elevation myocardial infarction (STEMI) patients. <b><i>Methods:</i></b> Blood samples for plasma NGAL in 132 STEMI patients were drawn immediately before and 24 h following primary coronary intervention. Abnormal elevation of NGAL levels was defined using the cardiac surgery-associated NGAL score with NGAL levels ≥100 ng/mL suggesting renal tubular damage. According to NGAL levels at 0 and 24 h, patients were stratified into 3 groups: no tubular damage (NGAL &#x3c;100 ng/mL in both exams), reversible tubular damage (NGAL &#x3e;100 ng/mL at 0 h but &#x3c;100 ng/mL at 24 h), and persistent tubular damage (NGAL &#x3e;100 ng/mL at both 0 and 24 h). <b><i>Results:</i></b> Mean age was 62 ± 13 years, and 78% were men. Of these patients, 29/132 (22%) demonstrated reversible tubular damage, and 36/132 (27%) persistent tubular damage. Only 13/132 patients (10%) progressed to clinical acute kidney injury during hospitalization, all of whom had persistent tubular injury. In multivariate regression model, symptom duration was independently associated with persistent tubular damage, both as continues variable (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.04; <i>p</i> = 0.04) and for symptom duration &#x3e;360 min (OR 2.66, 95% CI 1.07–6.63; <i>p</i> = 0.03). <b><i>Conclusions:</i></b> Renal tubular damage is common among STEMI patients. Dynamic NGAL measurement may differentiate between reversible and persistent tubular damage. Further trials are needed in order to assess the complex cardiorenal interactions.

scholarly journals Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in children after cardiac surgery

2016 ◽  
Vol 56 (4) ◽  
pp. 230
Author(s):  
Meta Herdiana Hanindita ◽  
Riskky Vitria Prasetyo ◽  
Ninik Asmaningsih Soemyarso ◽  
I Ketut Alit Utamayasa ◽  
Paul Tahalele
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Creatinine Clearance ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Schwartz Formula ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Neutrophil Gelatinase

Background Acute kidney injury (AKI) is still diagnosed by measuring the estimated creatinine clearance (eCCl), despite the fact that it may not change until 50% or more of kidney function has been lost. AKI after cardiac surgery is related to prolonged intensive care, decreased quality of life, and increased long term mortality. Neutrophil gelatinase-associated lipocalin (NGAL) represents an early biomarker of AKI, which may be useful for assessing AKI in cardiac patients.Objective To determine the validity of urinary and plasma NGAL as biomarkers for AKI in children after cardiac surgery.Methods Subjects were children who underwent cardiac surgery in Dr. Soetomo Hospital, Surabaya, Indonesia from August 2013 to January 2014. Serial urine and blood samples were analyzed for NGAL before surgery, as well as at 2h, 4h, 12h, and 24h after surgery. The AKI was established based on pRIFLE criteria. Estimated creatinine clearance (eCCl) was calculated from the estimated glomerular filtration rate (eGFR), according to age by the traditional Schwartz formula. Serum creatinine was assayed by the Jaffe method before surgery, as well as at 12h, 24h, 48h, and 72h after surgery.Results Of 20 subjects, 5 developed AKI. Urinary and plasma NGAL increased markedly at 2h postoperatively, as compared to eGFR which showed a rise at 12-48 h after cardiac surgery. Analysis of 2h post-operative urinary NGAL at a cut off value of 11.270ng/mL yielded an area under the curve (AUC) of 1.00 (95%CI 2.63 to 12.13), with sensitivity and specificity of 100% each for AKI. In addition, 2h post-operative plasma NGAL at a cut off value of 8.385 ng/mL yielded an AUC of 1.00 (95%CI 3.71 to 12.15) with sensitivity and specificity of 100% each for AKI.Conclusion Urinary and plasma NGAL are valid as early biomarkers for AKI in children after cardiac surgery.

scholarly journals Diagnostic relevance of neutrophil gelatinase-associated lipocalin in early detection of acute kidney injury

2020 ◽  
Vol 7 (2) ◽  
pp. 88-92
Author(s):  
Madhusudhan Mahadevaiah ◽  
Murali Mohan Nidasale Thimmaiah ◽  
Venu Sashank Yerramsetty ◽  
Jeevan Kumar ◽  
Ranjith Kumar
Keyword(s):  
Acute Kidney Injury ◽  
Diagnostic Accuracy ◽  
Point Of Care ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Point Of Care Test ◽  
Reliable Marker ◽  
Neutrophil Gelatinase

Objective: To evaluate the predictive and diagnostic accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury (AKI) and also to predict the renal replacement therapy (RRT) using NGAL as a marker. Methods: This prospective study was conducted among the patients admitted to intensive care units. Plasma samples were collected 24 hours after admission and NGAL was measured using Triage® NGAL test, a specific point of care test which is based on the mechanism of fluorescence immunoassay. The diagnostic accuracy of plasma NGAL (pNGAL) to predict AKI in critically ill patients of ICU was assessed by applying receiver operator curve (ROC) analysis and calculating the area under the curve (AUC). Results: In this study, 100 patients with the mean age of 49.56±19.2 years were included for the period of 18 months. The blood samples were withdrawn from the patients 24 and 44 hours after admission. Totally, 55% (n=55) of ICU patients were diagnosed with AKI. Plasma NGAL level was significantly increased in AKI patients as compared to non-AKI patients (742.65±734.72 vs. 255.62±440.09 μg/L; P<0.01). The sensitivity and specificity of NGAL for diagnosing AKI was 83.6% and 88.9%, respectively. The overall diagnostic accuracy was 86%. Diagnostic accuracy of NGAL for requirement of RRT was 51%. Conclusion: Plasma NGAL is a reliable marker for patients with AKI in ICU, in case the cause of kidney injury is not known. In addition, NGAL also predicts the RRT need based on AKI severity.

scholarly journals Relationship between neutrophil gelatinase-associated lipocalin, cardiac biomarkers, inflammation index and renal parameters in cardiovascular disease

2019 ◽  
Vol 71 (4) ◽  
pp. 621-628
Author(s):  
Jong Choi ◽  
Moon Lee ◽  
Tatsuyoshi Fujii
Keyword(s):  
Kidney Function ◽  
Troponin I ◽  
Myocardial Dysfunction ◽  
Cardiac Biomarkers ◽  
Ngal Level ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Creatine Kinase Mb ◽  
Index Ratio ◽  
Neutrophil Gelatinase

The plasma neutrophil gelatinase-associated lipocalin (NGAL) level is elevated in myocardial infarction (MI) and affected by inflammation and kidney function. The aim of this study was to determine which of these conditions more critically affects the plasma NGAL level in MI. Patients with MI were evaluated by measuring the NGAL concentration and its corrected values. No significant association was observed between plasma NGAL concentration and cardiac biomarkers. However, the NGAL/inflammation index ratio (NGAL/Inf ratio) was positively correlated with troponin-I (r=0.289, p<0.001), and the NGAL/serum creatinine ratio (NGAL/sCr ratio) was significantly correlated with creatine kinase-MB (r=0.251, p<0.001). After adjusting for inflammation and kidney function, increased NGAL concentrations returned to baseline levels, which were not different from those of healthy individuals. The percent difference between NGAL and the NGAL/Inf ratio was 35.6%, significantly higher than that between NGAL and the NGAL/sCr ratio (15.4%; p<0.001). The severity of inflammation seems to play a more crucial role than renal and myocardial dysfunction in affecting plasma NGAL levels in MI. Plasma NGAL levels need to be corrected using the inflammation index and sCr levels for exactly evaluating patients with MI.

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