CSA-NGAL score

A potential tool to monitor acute tubular damage

The Cardiac Surgery-Associated NGAL score - as presented in a new article by an expert group.

 

 Authored by an expert group chaired by Dr. Jean-Louis Vincent. Introduction to CSA-NGAL score.

 

CSA-AKI incidence and interventions

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious postoperative complication and is the second most common cause of AKI in the ICU1. The success of interventions aimed to reduce CSA-AKI incidence and its related outcome depends on the best time to apply them, which is the very early stage of AKI2.

The authors introduce the use of NGAL as the biomarker to use in a new definition for acute tubular damage (the Cardiac Surgery Associated NGAL Score (CSA-NGAL score)) in order to further complement the functional diagnosis of AKI2.     

Detect acute tubular damage

The CSA-NGAL score an aid in the detection of acute tubular damage

CSA-NGAL score is created - assist in further complement of functional diagnosis of AKI.

Use urine or plasma NGAL measurements according to hospital preference and availability, as no superiority is shown in current evidence2.

              

CSA-NGAL score - clinical implications

CSA-NGAL score: An addition to current standards

The CSA-NGAL score is to be seen as an addition to RIFLE, AKIN or KDIGO scores.

The CSA-NGAL score has the ability to identify tubular damage in patients not yet displaying clinical dysfunction2:

RIFLE stages R-F | AKIN stages 1-3 | KDIGO stages 1-3

This early indication of acute tubular damage preceding functional loss could trigger appropriate therapeutic modifications2.                                         

Sequential measurements

The optimal implement of NGAL measurements in cardiac surgery routines, would be to add them as a monitoring tests2:

  • Baseline pre-surgery (within 24 hours prior to procedure)
  • Post-surgery 4-6 hours after commencing surgery (knife to skin)
  • Day 1 (within 6-12 hours of returning to the ICU)

References

1. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a 269 multinational, multicenter study. JAMA. 2005;294:813-818. Link.

2. de Geus HR, Ronco C, Haase M, Jacob L, Lewington A, Vincent J-L, The cardiac surgery-associated NGAL score: a potential tool to monitor acute tubular damage, The Journal of Thoracic and Cardiovascular Surgery (2016), doi: 10.1016/j.jtcvs.2016.01.037. Link.