Objective. Neutrophil gelatinase-associated lipocalin (NGAL) measured by a research ELISA is described as an early marker of acute kidney injury (AKI). The aim of this study is to define the usefulness of plasma NGAL (pNGAL) and urine NGAL (uNGAL) measured with platform analysers to detect AKI 3 hours after cardiac surgery in fifty adult patients. Methods and Main Results. pNGAL and uNGAL were measured before and 3 hours after cardiac surgery. AKI, defined following the acute kidney injury network definition, was observed in 17 patients. pNGAL was >149？ng/mL in 8 patients with AKI, two of them died in the follow-up. We also observed elevated pNGAL in 8 patients without AKI. Only one uNGAL was >132？ng/mL among the 15 AKI patients. Sensitivity of pNGAL for prediction of AKI is 47% and specificity is 75.7%. The positive likelihood ratio (LR+) is 1.9 and negative likelihood ratio (LR？) is 0.7. uNGAL performance is slightly improved when reported to urinary creatinine. Following this study, a ratio >62？ng/mg assure a sensitivity of 66.6% and a specificity of 78.5%. LR+ is 3 and a LR？ is, 0.42. Conclusions. Three hours after cardiac surgery, pNGAL predicts AKI with a low sensitivity and specificity. 1. Introduction Acute kidney injury (AKI) is a major postoperative complication after cardiac surgery [1, 2]. This is associated with increased mortality, prolonged ICU length of stay, and sometimes prolonged kidney dysfunction [3]. Prompt diagnosis could lead to hemodynamic optimization and could prevent progression of AKI. The most recognised criteria for the diagnosis of AKI are currently based on the RIFLE score or AKIN modified score which is based on the serum creatinine variation and the urine output [4, 5]. It is commonly described that serum creatinine elevation is a late indicator of kidney dysfunction and that the steady state is reached lately (sometimes up to 48–72 hours) while half the kidney function was already lost [6, 7]. Last few years, some new biomarkers appear to be promising for the rapid diagnosis of AKI compared to classical indicators such as serum creatinine or urine output: cystatin C, interleukin 18 (IL-18), kidney injury molecule (KIM1), liver fatty acid binding protein (LFABP), and neutrophil gelatinase-associated lipocalin (NGAL). NGAL appears to be the most promising marker, but there are conflicting observations concerning the validity of this expensive test. Neutrophil gelatinase-associated lipocalin (NGAL) is a member of the lipocalin superfamily of more than 20 structurlaly related secreted proteins and thought to participate
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