Early detection of acute kidney injury in the perioperative period of liver transplant with neutrophil gelatinase-associated lipocalin

Autor(es)

Lima, Camila ^{[1, 2, 3]} ; de Paiva Haddad, Luciana Bertocco ^[4] ; Vaz de Melo, Patricia Donado ^[5] ; Malbouisson, Luiz Marcelo ^[6] ; Freitas do Carmo, Lilian Pires ^{[2, 3]} ; Carneiro D'Albuquerque, Luiz Augusto ; Macedo, Etienne ^{[2, 3, 7]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Dept Med Surg Nursing, Nursing Sch, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Dept Internal Med, Nephrol Div, Sao Paulo - Brazil

^[3] 419 Av Dr Eneas de Carvalho Aguiar, Third Floor, BR-05403000 Sao Paulo, SP - Brazil

^[4] Univ Sao Paulo, Dept Gastrointestinal Surg, Clin Surg Div, Sao Paulo - Brazil

^[5] Univ Fed Minas Gerais, Dept Biol, Biochem Div, Belo Horizonte, MG - Brazil

^[6] Univ Sao Paulo, Dept Anaesthesiol, Clin Surg Div, Sao Paulo - Brazil

^[7] Univ Calif San Diego, Nephrol Div, Dept Med, San Diego, CA 92103 - USA

• Tipo de documento: Artigo Científico
• Fonte: BMC Nephrology; v. 20, n. 1 OCT 15 2019.
• Citações Web of Science: 0

Resumo

Background Acute kidney injury (AKI) is a common complication in patients undergoing liver transplant (LT) and is associated with high morbidity and mortality. We aim to evaluate the pattern of urine and plasma neutrophil gelatinase-associated lipocalin (NGAL) elevation during the perioperative period of LT and to assess it as a prognostic marker for AKI progression, need for dialysis and mortality. Methods We assessed NGAL levels before induction of anesthesia, after portal reperfusion and at 6, 18, 24, and 48 h after surgery. Patients were monitored daily during the first week after LT. Results Of 100 enrolled patients undergoing liver transplant, 59 developed severe AKI based on the KDIGO serum creatinine (sCr) criterion; 34 were dialysed, and 21 died within 60 days after LT. Applying a cut-off value of 136 ng/ml, UNGAL values 6 h after surgery was a good predictor of AKI development within 7 days after surgery, having a positive predictive value (PPV) of 80% with an AUC of 0.76 (95% CI 0.67-0.86). PNGAL at 18 h after LT was also a good predictor of AKI in the first week, having a PPV of 81% and AUC of 0.74 (95% CI 0.60-0.88). Based on PNGAL and UNGAL cut-off criteria levels, time to AKI diagnosis was 28 and 23 h earlier than by sCr, respectively. The best times to assess the need for dialysis were 18 h after LT by PNGAL and 06 h after LT by UNGAL. Conclusion In conclusion, the plasma and urine NGAL elevation pattern in the perioperative period of the liver transplant can predict AKI diagnosis earlier. UNGAL was an early independent predictor of AKI development and need for dialysis. Further studies are needed to assess whether the clinical use of biomarkers can improve patient outcomes. (AU)

• Processo FAPESP: 13/12710-2 - Diagnóstico e aplicação dos biomarcadores de injúria renal aguda no perioperatório de transplante hepático
• Beneficiário: Etienne Maria Vasconcellos de Macedo
• Modalidade de apoio: Auxílio à Pesquisa - Regular