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Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study.

Publication ,  Journal Article
Moledina, DG; Parikh, CR; Garg, AX; Thiessen-Philbrook, H; Koyner, JL; Patel, UD; Devarajan, P; Shlipak, MG; Coca, SG; TRIBE-AKI Consortium,
Published in: PLoS One
2015

BACKGROUND: Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown. METHODS: In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality. RESULTS: During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Pre-operative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04-2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0-1.7 and adjusted HR 1.78, 95% CI 1.2-2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79-1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87-1.61 for peak pNGAL). CONCLUSIONS: Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2015

Volume

10

Issue

6

Start / End Page

e0129619

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Proto-Oncogene Proteins
  • Prospective Studies
  • Perioperative Period
  • Mortality
  • Middle Aged
  • Male
  • Lipocalins
  • Lipocalin-2
 

Citation

APA
Chicago
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Moledina, D. G., Parikh, C. R., Garg, A. X., Thiessen-Philbrook, H., Koyner, J. L., Patel, U. D., … TRIBE-AKI Consortium, . (2015). Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study. PLoS One, 10(6), e0129619. https://doi.org/10.1371/journal.pone.0129619
Moledina, Dennis G., Chirag R. Parikh, Amit X. Garg, Heather Thiessen-Philbrook, Jay L. Koyner, Uptal D. Patel, Prasad Devarajan, Michael G. Shlipak, Steven G. Coca, and Steven G. TRIBE-AKI Consortium. “Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study.PLoS One 10, no. 6 (2015): e0129619. https://doi.org/10.1371/journal.pone.0129619.
Moledina, Dennis G., et al. “Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study.PLoS One, vol. 10, no. 6, 2015, p. e0129619. Pubmed, doi:10.1371/journal.pone.0129619.
Moledina DG, Parikh CR, Garg AX, Thiessen-Philbrook H, Koyner JL, Patel UD, Devarajan P, Shlipak MG, Coca SG, TRIBE-AKI Consortium. Association of Perioperative Plasma Neutrophil Gelatinase-Associated Lipocalin Levels with 3-Year Mortality after Cardiac Surgery: A Prospective Observational Cohort Study. PLoS One. 2015;10(6):e0129619.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2015

Volume

10

Issue

6

Start / End Page

e0129619

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Proto-Oncogene Proteins
  • Prospective Studies
  • Perioperative Period
  • Mortality
  • Middle Aged
  • Male
  • Lipocalins
  • Lipocalin-2