Recent studies published demonstrates the clinical value of NGAL as a biomarker in addition to current AKI guidelines (KDIGO, AKIN, RIFLE), as the addition of NGAL is an advancement in the detection and prevention of AKI in critically ill patients. NGAL will at the same time introduce clinicians to overall costs savings2,3,4.
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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.
Use urine or plasma NGAL measurements according to hospital preference and availability, as no superiority is shown in current evidence2.
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
The optimal implement of NGAL measurements in cardiac surgery routines, would be to add them as a monitoring tests2:
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.
3. Tecson, KM. et. al Optimal cut points of plasma and urine neutrophil gelatinase-associated lipocalin for the prediction of acute kidney injury among critically ill adults: retrospective determination and clinical validation of a prospective multicentre study, BMJ Open; 2017; Jul10;7(7)e:016028. Link.
4. Parikh, A. et. al. Does NGAL reduce costs? A cost analysis of urine NGAL (uNGAL) & serum creatinine for acute kidney injury (AKI) diagnosis, PLoS One; 2017; May19; 12(5)e:178091. Link.