SESSION TITLE: Critical Care - It's Not Just the Lungs
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Contrast induced acute kidney injury (CI-AKI) following a percutaneous coronary intervention (PCI) is the third cause of AKI. Patients who required hemodialysis secondary to CI-AKI have an associated mortality of 55%. The current definition of CI-AKI is based on the elevation of creatinine and decreased of urinary output. Creatinine typically increases 24 hours after the renal injury what delays the diagnosis and possible treatment of CI-AKI. The neutrophil gelatinase associated lipocalin (NGAL) has emerged as a sensitive and specific biomarker of renal injury. Limited data exists about the effectiveness of NGAL to predict CI-AKI in patients with acute coronary syndrome (ACS) that required PCI. The aim of this study was to determine the association of serum levels of NGAL and the need for hemodialysis after PCI.
METHODS: This is a prospective, observational cohort study at a single institution in Bogota, Colombia. We included patients with ACS that required PCI with a high risk to develop CI-AKI defined by a Mehran score of >11 points. Blood samples were obtained at baseline, 6 and 24 hours after the angiographic procedure. NGAL levels were measured using AlereTM Triage® NGAL inmunoassay. The primary outcome was the requirement of hemodialysis. The non-parametric Mann-Whitney U Test was used to test for differences in median (IQR) serum concentrations of NGAL. Statistical significance was defined as p-value < 0.05. A receiver operating characteristic (ROC) curve was developed to assess the accuracy of NGAL to predict hemodialysis after PCI.
RESULTS: 45 patients were included in the study. No statistically significant differences were observed in demographic, comorbid conditions and admission diagnosis among patients who required or not hemodialysis. The median (IQR) serum concentration of NGAL was greater in patients who required hemodialysis versus patients that not (340 [83-384] vs. 169 [100-210], p=0.01). Elevated serum levels of NGAL were identified as a predictor hemodialysis with an area under the curve (AUC) of 0.86 (95% Confidence Interval: 0.66-1.00).
CONCLUSIONS: Elevated levels of NGAL at 6 hours post intervention predicts the requirement of hemodialysis after PCI in patients with ACS and high risk of develops CI-AKI.
CLINICAL IMPLICATIONS: The early detection of CI-AKI could improve outcomes in patients with ACS.
DISCLOSURE: The following authors have nothing to disclose: Felipe Reyes, Carlos Bustamante, Juan Vargas, Jaqueline Perea, Ricardo Buitrago, Efrain Gomez, Marcos Restrepo
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