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Neutrophil gelatinase-associated lipocalin reflects inflammation and is not a reliable renal biomarker in neonates and infants after cardiopulmonary bypass: a prospective case–control study

Published online by Cambridge University Press:  11 September 2017

Karl Reiter Open the ORCID record for Karl Reiter [Opens in a new window] ,
Gunter Balling ,
Vittorio Bonelli ,
Jelena Pabst von Ohain ,
Siegmund Lorenz Braun ,
Peter Ewert  and
Bettina Ruf
Karl Reiter*
Affiliation:
Paediatric Intensive Care Unit, University Children’s Hospital, von Haunersche Kinderklinik, Ludwig-Maximilians-Universitaet, Munich, Germany
Gunter Balling
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Muenchen, Technische Universitaet, Germany
Vittorio Bonelli
Affiliation:
Department of Anaesthesiology, Deutsches Herzzentrum Muenchen, Technische Universitaet, Germany
Jelena Pabst von Ohain
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Deutsches Herzzentrum Muenchen, Technische Universitaet, Germany
Siegmund Lorenz Braun
Affiliation:
Institute of Laboratory Medicine, Deutsches Herzzentrum Muenchen, Technische Universitaet, Germany
Peter Ewert
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Muenchen, Technische Universitaet, Germany
Bettina Ruf
Affiliation:
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum Muenchen, Technische Universitaet, Germany
*
Correspondence to: K. Reiter, MD, Paediatric Intensive Care Unit, University Children’s Hospital, von Haunersche Kinderklinik, Ludwig-Maximilians-Universitaet, Munich 80337, Germany. Tel: ++49 89 44005 2811; Fax: ++49 89 44005 4499; E-mail: karl.reiter@med.uni-muenchen.de
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Abstract

Introduction

Acute kidney injury is a frequent complication after cardiac surgery with cardiopulmonary bypass in infants. Neutrophil gelatinase-associated lipocalin has been suggested to be a promising early biomarker of impending acute kidney injury. On the other hand, neutrophil gelatinase-associated lipocalin has been shown to be elevated in systemic inflammatory diseases without renal impairment. In this secondary analysis of data from our previous study on acute kidney injury after infant cardiac surgery, our hypothesis was that neutrophil gelatinase-associated lipocalin may be associated with surgery-related inflammation.

Methods

We prospectively enrolled 59 neonates and infants undergoing cardiopulmonary bypass surgery for CHD and measured neutrophil gelatinase-associated lipocalin in plasma and urine and interleukin-6 in the plasma. Values were correlated with postoperative acute kidney injury according to the paediatric Renal-Injury-Failure-Loss-Endstage classification.

Results

Overall, 48% (28/59) of patients developed acute kidney injury. Of these, 50% (14/28) were classified as injury and 11% (3/28) received renal replacement therapy. Both plasma and urinary neutrophil gelatinase-associated lipocalin values were not correlated with acute kidney injury occurrence. Plasma neutrophil gelatinase-associated lipocalin showed a strong correlation with interleukin-6. Urinary neutrophil gelatinase-associated lipocalin values correlated with cardiopulmonary bypass time.

Conclusion

Our results suggest that plasma and urinary neutrophil gelatinase-associated lipocalin values are not reliable indicators of impending acute kidney injury in neonates and infants after cardiac surgery with cardiopulmonary bypass. Inflammation may have a major impact on plasma neutrophil gelatinase-associated lipocalin values in infant cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin may add little prognostic value over cardiopulmonary bypass time.

Keywords

Acute kidney injuryneutrophil gelatinase-associated lipocalininflammationinterleukin-6CHDcardiopulmonary bypass
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 243 - 251
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Copyright
© Cambridge University Press 2017 

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Footnotes

The data were presented as an abstract at the AEPC 2014 in Helsinki, Finland.

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