Plasma Neutrophil Gelatinase-Associated Lipocalin Measured Immediately After Restoration of Spontaneous Circulation Predicts Acute Kidney Injury in Cardiac Arrest Survivors Who Underwent Therapeutic Hypothermia

摘要

Early diagnosis of acute kidney injury (AKI) after cardiac arrest (CA) is challenging. We aimed to identify the diagnostic and prognostic performance of neutrophil gelatinase-associated lipocalin (NGAL) for AKI and its clinical outcomes. A retrospective observational study, involving adult comatose CA survivors treated with therapeutic hypothermia between May 2013 and December 2016, was conducted. AKI was classified according to the guidelines of Kidney Disease Improving Global Outcomes. NGAL levels were measured after return of spontaneous circulation (ROSC). The primary outcome was development of AKI within 7 days after CA, and the secondary outcome was inhospital mortality. The study included 279 patients, of which 111 (39.8%) developed AKI and 61 (21.9%) died. Thirty-seven (33.3%) of patients in the AKI group had stage 3 AKI, and 45 (40.5%) patients received renal replacement therapy. The area under the curve of NGAL levels for diagnosing AKI was 0.725 (95% confidence interval [CI] 0.668-0.776), and NGAL levels were independently associated with the development of AKI (odds ratio [OR] 1.004; 95% CI 1.002-1.006). Nonsurvivors had significantly higher NGAL levels (221.0 ng/mL [154.0-355.5] vs. 148.5 ng/mL [97.0-232.9]; p<0.001). The development of AKI was independently associated with mortality (OR 4.926; 95% CI 2.353-10.311); however, NGAL level was not associated with mortality (OR 1.000; 95% CI 0.999-1.001). Plasma NGAL level measured after ROSC can be an early predictor for the development of AKI after CA. The presence of AKI was associated with increased inhospital mortality.