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Neutrophil gelatinase-associated lipocalin, cystatin C and eGFR indicate acute kidney injury and predict prognosis of patients with acute pulmonary embolism
  1. Maciej Kostrubiec1,
  2. Andrzej Łabyk1,
  3. Justyna Pedowska-Włoszek1,
  4. Olga Dzikowska-Diduch1,
  5. Artur Wojciechowski2,
  6. Marzena Garlińska3,
  7. Michał Ciurzyński1,
  8. Piotr Pruszczyk1
  1. 1Department of Internal Medicine and Cardiology, The Medical University of Warsaw, Warsaw, Poland
  2. 2Department of Radiology, The Medical University of Warsaw, Warsaw, Poland
  3. 3Department of Immunology, Transplantology and Internal Medicine, The Medical University of Warsaw, Warsaw, Poland
  1. Correspondence to Dr Maciej Kostrubiec, Department of Internal Medicine and Cardiology, The Medical University of Warsaw, ul. Lindleya 4, 02-005 Warszawa, Poland; maciej.kostrubiec{at}wum.edu.pl

Abstract

Objective Risk stratification in acute pulmonary embolism (APE) includes the assessment of clinical status, right ventricular dysfunction and troponin concentrations. Since acute renal impairment is one of the important predictors of mortality in cardiovascular diseases, the authors hypothesised that it is an independent mortality marker in APE.

Material and methods The authors observed 142 consecutive patients (52 M/90 F, 64±18 years) with APE diagnosed with contrast enhanced multislice CT. On admission, blood samples were collected for neutrophil gelatinase-associated lipocalin (N-GAL), cystatin C and creatinine assays. Estimated glomerular filtration rate (eGFR) was calculated using MDRD formula.

Results Fourteen (10%) of 142 patients died by the 30th day of observation. eGFR≤60 ml/min was noted in 68 (48%) patients and eGFR≤30 ml/min in 11 (8%) patients. eGFR was higher in survivors than in non-survivors (66 (17–169) vs 46 (10–119) ml/min, respectively, p=0.02). In 80 (56%) patients, N-GAL was >50 ng/ml indicating acute kidney injury. N-GAL was higher in non-survivors than in survivors (88.8 (28.4–200.0) vs 53.0 (7.1–200.0) ng/ml, p<0.01). N-GAL level >50 ng/ml was found in 11 (79%) patients with fatal outcome. Area under the curve of N-GAL for all-cause mortality in ROC analysis was 0.715. N-GAL>75 ng/ml was present in 44 (31%) patients, while cystatin C >1900 ng/ml in 14 (10%) subjects. They showed sensitivity, specificity, positive predictive value and negative predictive value for prediction of all-cause death ((64%, 73%, 21%, 95%) and (36%, 91%, 30% 93%), respectively). N-GAL>75 ng/ml and cystatin C>1900 ng/ml increased the risk of death (HR 4.4 (95% CI 1.48 to 13.2, p<0.01) and 4.7 (95% CI 1.56 to 13.9, p=0.01), respectively).

Conclusions Acute kidney injury assessed by N-GAL occurs in 30% of APE and may contribute to the impairment of renal function present in half of them. Moreover, N-GAL, cystatin C elevation and low eGFR are associated with a poor 30-day prognosis in APE.

  • Renal failure
  • mortality
  • N-GAL
  • cystatin C
  • eGFR
  • prognosis
  • pulmonary embolism
  • allied specialities
  • emergency medicine
  • haematology
  • venous thromboembolism
  • endothelium
  • endothelial function
  • renal disease
  • renovascular disease
  • quality of care and outcomes
  • cardiorenal syndrome
  • valvular disease
  • aortic valve disease
  • mitral stenosis
  • aorta
  • great vessels and trauma

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Footnotes

  • See Editorial, p 1185

  • Funding This study was supported by a grant from MNiSzW: N N402 490140.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by The Bioethics Committee of the Medical University of Warsaw.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement Additional unpublished data are available only from the first author and can be included to the paper on editor or reviewer demand.

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