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Coronary artery disease
Original research article
Neutrophil gelatinase-associated lipocalin prior to cardiac surgery predicts acute kidney injury and mortality
  1. Heerajnarain Bulluck1,2,3,
  2. Raju Maiti4,
  3. Bibhas Chakraborty4,
  4. Luciano Candilio2,
  5. Tim Clayton5,
  6. Richard Evans5,
  7. David P Jenkins3,
  8. Shyam Kolvekar6,
  9. Gudrun Kunst7,
  10. Christopher Laing8,
  11. Jennifer Nicholas5,
  12. John Pepper9,
  13. Derek M Yellon2,10,
  14. Derek J Hausenloy1,2,6,9,10,11,12
  1. 1 National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
  2. 2 The Hatter Cardiovascular Institute, University College, London, UK
  3. 3 Papworth Hospital, Cambridge, UK
  4. 4 Centre for Quantitative Medicine Duke-NUS Medical School Academia, Singapore, Singapore
  5. 5 Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
  6. 6 Barts Heart Centre, St Bartholomew’s Hospital, London, UK
  7. 7 Anaesthetics, Intensive Care Medicine and Perioperative Pain Medicine, King’s College Hospital and King’s College London, London, UK
  8. 8 The Royal Free Hospital, London, UK
  9. 9 National Institute of Health Research Cardiovascular Biomedical Research Unit at Royal Brompton & Harefield National Health Service Trust, London, UK
  10. 10 The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
  11. 11 Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
  12. 12 Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
  1. Correspondence to Professor Derek J Hausenloy, Cardiovascular & Metabolic Diseases Program, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore 169857; derek.hausenloy{at}duke-nus.edu.sg

Abstract

Objective We aimed to investigate whether preoperative serum neutrophil gelatinase-associated lipocalin (sNGALpre-op) predicted postoperative acute kidney injury (AKI) during hospitalisation and 1-year cardiovascular and all-cause mortality following adult cardiac surgery.

Methods This study was a post hoc analysis of the Effect of Remote Ischemic Preconditioning on Clinical Outcomes in Patient Undergoing Coronary Artery Bypass Graft Surgery trial involving adult patients undergoing coronary artery bypass graft. Postoperative AKI within 72 hours was defined using the International Kidney Disease: Improving Global Outcomes classification.

Results 1371 out of 1612 patients had data on sNGALpre-op. The overall 1-year cardiovascular and all-cause mortality was 5.2% (71/1371) and 7.7% (105/1371), respectively. There was an observed increase in the incidence of AKI from the first to the third tertile of sNGALpre-op (30.5%, 41.5% and 45.9%, respectively, p<0.001). There was also an increase in both cardiovascular and all-cause mortality from the first to the third tertile of sNGALpre-op, linear trend test with adjusted p=0.018 and p=0.013, respectively. The adjusted HRs for those in the second and third tertiles of sNGALpre-op compared with the first tertile were 1.60 (95% CI 0.78 to 3.25) and 2.22 (95% CI 1.13 to 4.35) for cardiovascular mortality, and 1.25 (95% CI 0.71 to 2.22) and 1.91 (95% CI 1.13 to 3.25) for all-cause mortality at 1 year.

Conclusion In a cohort of high-risk adult patients undergoing cardiac surgery, there was an increase in postoperative AKI and 1-year mortality from the first to the third tertile of preoperative serum NGAL. Those in the last tertile (>220 ng/L) had an estimated twofold increase risk of cardiovascular and all-cause mortality at 1 year.

Clinical trial registration NCT101247545; Post-results.

  • coronary artery disease
  • coronary artery disease surgery

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/heartjnl-2017-311760

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    Footnotes

    • Contributors Conception this work: HB, LC, DMY and DJH. Acquisition of the data: LC, RE, DJ, SKM, GK, CL, JPM and DMY. Analysis and interpretation of the data: HB, RM, BC, JN, TC and DJH. Drafting of the manuscript: HB, RM, BC, LC and DJH. Critical review of the manuscript: CL, DMY, DJH, TC, LC, GK, DJ, JN, JPM, SKM and CL. Final approval of the version to be published: all authors. Guarantor of this work: DJH.

    • Funding The ERICCA study was supported by grants from the Efficacy and Mechanism Evaluation Program (a Medical Research Council and National Institute of Health Research partnership) (09/100/05) and the British Heart Foundation. Part of this work was supported by the National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, the British Heart Foundation(FS/10/039/28270), Duke-National University Singapore Medical School, the Singapore Ministry of Health’s National Medical Research Council under its Clinician Scientist-Senior Investigator scheme (NMRC/CSA7SI/0011/2017) and Collaborative Centre Grant scheme (NMRC/CGAug16C006) and the Singapore Ministry of Education Academic Research Fund Tier 2 (MOE20167T2727021).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval This study was approved by the National Health Service Research Ethics Committee, and all patients provided informed written consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.