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PLoS One. 2015 Jun 8;10(6):e0129619. doi: 10.1371/journal.pone.0129619. eCollection 2015.

Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study.

Author information

1
Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America; VA CT Healthcare System, West Haven, Connecticut, United States of America; Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
2
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
3
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
4
Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, United States of America.
5
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, United States of America.
6
Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America.
7
Division of General Internal Medicine, San Francisco VA Medical Center, University of California, San Francisco, California, United States of America.

Abstract

BACKGROUND:

Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown.

METHODS:

In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality.

RESULTS:

During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Pre-operative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04-2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0-1.7 and adjusted HR 1.78, 95% CI 1.2-2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79-1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87-1.61 for peak pNGAL).

CONCLUSIONS:

Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.

PMID:
26053382
PMCID:
PMC4460181
DOI:
10.1371/journal.pone.0129619
[Indexed for MEDLINE]
Free PMC Article
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