Early prediction of contrast-induced acute kidney injury by a "bedside" assessment of Neutrophil Gelatinase-Associated Lipocalin during elective percutaneous coronary interventions

Contrast-induced acute kidney injury (CI-AKI) is a serious complication during percutaneous coronary interventions (PCI). Currently, the diagnosis of CI-AKI relies on serum creatinine (SCr) that is however affected by several limitations potentially leading to delayed or missed diagnoses. In this st...

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Bibliographic Details
Published in:PloS one 2018-05, Vol.13 (5), p.e0197833-e0197833
Main Authors: Nusca, Annunziata, Miglionico, Marco, Proscia, Claudio, Ragni, Laura, Carassiti, Massimiliano, Lassandro Pepe, Francesca, Di Sciascio, Germano
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angioplasty
Biological markers
Biology and Life Sciences
Biomarkers
Care and treatment
Clinical medicine
Correlation
Creatinine
Diagnosis
Diagnostic systems
Gelatinase
Health aspects
Heart attacks
Heart failure
Intervention
Kidney diseases
Kidneys
Laboratories
Lipocalin
Medicine and Health Sciences
Mortality
Neutrophils
Patients
Predictions
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Summary:Contrast-induced acute kidney injury (CI-AKI) is a serious complication during percutaneous coronary interventions (PCI). Currently, the diagnosis of CI-AKI relies on serum creatinine (SCr) that is however affected by several limitations potentially leading to delayed or missed diagnoses. In this study we examined the diagnostic accuracy of a "bedside" measurement of plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL) in the early detection of CI-AKI in 97 patients undergoing elective PCI. The overall incidence of CI-AKI was 3%. A significant positive correlation was observed between 6-hours NGAL and post-PCI SCr (r = 0.339, p = 0.004) and a significant negative correlation between 6-hours NGAL and post-PCI CrCl (r = -0.303, p = 0.010). In patients with post-PCI SCr increase > 0.24 mg/dl (median SCr absolute increase), delta NGAL 0-6 hours and 6-hours NGAL values were higher compared with patients with SCr elevation below the defined threshold (p = 0.049 and p = 0.056). The ROC analysis showed that a 6 hours NGAL value > 96 ng/ml significantly predicted an absolute SCr increase > 0.24 mg/dl after contrast exposure with sensitivity of 53% and specificity of 74% (AUC 0.819, 95% CI: 0.656 to 0.983, p = 0.005). The use of bedside NGAL assessment may significantly hasten diagnosis and treatment of CI-AKI, with remarkable clinical prognostic consequences.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0197833