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Circ Cardiovasc Interv · Sep 2015
Clinical TrialNeutrophil Gelatinase-Associated Lipocalin and Contrast-Induced Acute Kidney Injury.
- Cristina Quintavalle, Chiara Viviani Anselmi, Francesca De Micco, Giuseppina Roscigno, Gabriella Visconti, Bruno Golia, Amelia Focaccio, Bruno Ricciardelli, Enzo Perna, Laura Papa, Elvira Donnarumma, Gerolama Condorelli, and Carlo Briguori.
- From the Department of Molecular Medicine and Medical Biotechnology, "Federico II" University, Naples, Italy (C.Q., E.P., G.C.); Institute of Genetics and Biomedical Research, Milan Unit, Milan, Italy (C.V.A., E.D.); Humanitas Research Hospital, Rozzano, Italy (C.V.A., E.D.); Laboratory of Interventional Cardiology and Department of Cardiology, Clinica Mediterranea, Naples, Italy (F.D.M., G.V., B.G., A.F., B.R., C.B.); Institute for Endocrinology and Experimental Oncology, National Research Council, Naples, Italy (G.R., L.P., G.C.); and SDN Foundation, Naples, Italy (E.D.).
- Circ Cardiovasc Interv. 2015 Sep 1; 8 (9): e002673.
BackgroundNeutrophil gelatinase-associated lipocalin (NGAL) is an early marker of acute kidney injury (AKI).Methods And ResultsUrine NGAL and serum NGAL (sNGAL) were assessed at 2, 6, 24, and 48 hours after contrast media (CM) exposure in 458 high-risk patients (development set). Optimal thresholds in predicting contrast-induced AKI (serum creatinine [sCr] increase ≥0.3 mg/dL at 48 hours after CM administration) were identified. Major adverse events (MAE; death, dialysis, nonfatal myocardial infarction, sustained kidney injury, and myocardial revascularization) at 1 year were assessed. In the development set, optimal thresholds for contrast-induced AKI occurred at 6 hours for both urine NGAL (≥20 ng/mL; 97% negative predictive value and 27% positive predictive value) and sNGAL (≥179 ng/mL; 93% negative predictive value and 20% positive predictive value). Furthermore, sNGAL ≥179 ng/mL at 6 hours was an independent predictor of 1-year MAE. 1-year MAE occurred in 27/198 patients (13.5%) with sNGAL <179 ng/mL and sCr <0.3 mg/dL, in 57/193 (29.5%) patients with only sNGAL ≥179 ng/mL, and in 37/67 (55%) patients with sCr ≥0.3 mg/dL. In additional 253 patients (validation set), no patient with urine NGAL <20 ng/mL or sNGAL <179 ng/mL at 6 hours developed contrast-induced AKI. Furthermore, 6/68 (9%) patients with sNGAL <179 ng/mL and sCr increase <0.3 mg/dL had 1-year MAE versus 17/57 (30%) patients with sNGAL ≥179 ng/mL and sCr increase <0.3 mg/dL and 8/16 (50%) patients with sCr increase ≥0.3 mg/dL.ConclusionsUrine NGAL <20 ng/mL and sNGAL <179 ng/mL at 6 hours are reliable markers for ruling out contrast-induced AKI. sNGAL ≥179 ng/mL at 6 hours predicts 1-year MAE.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT01098032.© 2015 American Heart Association, Inc.
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