抄録
Early intervention can significantly improve patient outcomes in acute kidney injury (AKI). In children with underdeveloped kidneys, it takes longer than 24 hours for serum creatinine (sCr) to peak after AKI onset. Furthermore, even very subtle increases in sCr are associated with poor outcomes, making it more difficult to diagnose early AKI in pediatric cases.
The urinary neutrophil gelatinase-associated lipocalin (NGAL) levels of 64 patients undergoing pediatric cardiac surgery using cardiopulmonary bypass from June 2018 to February 2019 were measured to evaluate NGAL as an accurate indicator of postoperative AKI.
Sixteen patients (25%) developed AKI. The AKI group showed significantly higher Risk Adjustment in Congenital Heart Surgery (RACHS-1) scores (p=0.028) and a significantly longer operative time (p=0.048), cardiopulmonary bypass time (p=0.048), and ventilator use time (p<0.001) than the non-AKI group. After surgery, urinary NGAL was significantly higher in the AKI group with a median of 37.1ng/mL (11.1-148.3) against 5.6ng/mL (1.0-35.8) of the non-AKI group (p=0.021). Using a cut-off value of 11.9ng/mL, the area under the curve of urinary NGAL for predicting AKI was 0.69, the sensitivity was 75%, and the specificity was 44%.
Higher RACHS-1 scores are associated with postoperative AKI. Urinary NGAL shows a moderate correlation with AKI diagnosis, and may be useful for predicting AKI early in the perioperative period.
