Urinary neutrophil gelatinase-associated lipocalin predicts renal injury following extracorporeal membrane oxygenation
Objective: To evaluate the course of urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 levels in young children during extracorporeal membrane oxygenation and concomitant continuous hemofiltration. Furthermore, to evaluate whether these levels predict outcome. Design: Prospective observational cohort study from July 2010 to July 2013. Setting: ICU of a level III university children's hospital. Patients: Thirty-one extracorporeal membrane oxygenation-treated children up to 1 year were included. Interventions: None. Measurements and Main Results: Patients were weaned from extracorporeal membrane oxygenation after a median of 162 hours (interquartile range, 83-304). Throughout the study, 58% of the patients met the criteria for acute kidney injury (i.e., Risk Injury Failure Loss End-Stage Renal Disease - Risk or higher defined as an increase in serum creatinine corresponding to ≥ 150% when compared with age-specific reference values). Levels of both biomarker patterns changed significantly throughout extracorporeal membrane oxygenation (urinary neutrophil gelatinase-associated lipocalin, p < 0.001 and urinary kidney injury molecule-1, p = 0.005, linear mixed model analyses). Urinary neutrophil gelatinase-associated lipocalin levels were already high before extracorporeal membrane oxygenation, whereas urinary kidney injury molecule-1 levels increased throughout the first extracorporeal membrane oxygenation day and peaked at 12-24 hours. Also, urinary neutrophil gelatinase-associated lipocalin levels at 12-24 hours of extracorporeal membrane oxygenation therapy were higher among patients with acute kidney injury post extracorporeal membrane oxygenation (p = 0.002, Mann-Whitney U test). Biomarker levels did not differ between survivors and nonsurvivors. Conclusions: The increased urinary neutrophil gelatinase-associated lipocalin and urinary kidney injury molecule-1 levels confirm that renal tubular damage occurs in critically ill infants in need of extracorporeal membrane oxygenation. The fact that the maximal urinary neutrophil gelatinase-associated lipocalin levels were measured 24 hours earlier than urinary kidney injury molecule-1 supports the use of biomarker combinations rather than a single biomarker to identify patients at risk of acute kidney injury. Finally, since urinary neutrophil gelatinase-associated lipocalin levels at 12-24 hours of extracorporeal membrane oxygenation therapy were associated with acute kidney injury post extracorporeal membrane oxygenation, this marker may facilitate more timely adjustment of therapeutic interventions.
|Keywords||acute kidney injury, biomarkers, critical care, extracorporeal membrane oxygenation, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin|
|Persistent URL||dx.doi.org/10.1097/PCC.0000000000000476, hdl.handle.net/1765/92440|
|Journal||Pediatric Critical Care Medicine|
Zwiers, A.J.M, Cransberg, K, de Rijke, Y.B, van Rosmalen, J.M, Tibboel, D, & de Wildt, S.N. (2015). Urinary neutrophil gelatinase-associated lipocalin predicts renal injury following extracorporeal membrane oxygenation. Pediatric Critical Care Medicine, 16(7), 663–670. doi:10.1097/PCC.0000000000000476