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Acute kidney injury (AKI) is a troublesome complication and is associated with an increased risk of mortality after coronary intervention. It usually takes over 48 hours to diagnose the development of AKI based on the elevation of serum creatinine. Recent developed the urinary neutrophil gelatinase associated lipocalin (U-NGAL) has a potent to detect the AKI at least 4 hours after coronary intervention. The aim of this study was to investigate whether U-NGAL was useful to identify the development of AKI after coronary intervention.
A total of 143 patients who had coronary intervention or angiography were enrolled. U-NGAL and serum Creatinine levels were measured on admission, and at 4 and 24 hours after procedure. The significant elevation of U-NGAL was defined as 50% increase of the baseine value and a greater than 30.5 ng/ml, that is, upper limit value calculated from the 95th percentile. The primary endpoint is the incidence of AKI based on the elevated levels of U-NGAL. The secondary endpoint was at 30-day mortality after procedure.
The median value of U-NGAL was 14.2 ng/ml (8.2 ng/ml [25th], 28.6 ng/ml [75th]). The incidence of AKI was observed in 23 patients (16%). Mortality rate was significantly higher in patients with the elevated levels of U-NGAL compared to those without the elevation of U-NGAL (8.7% vs. 0.8%, p=0.02). Multivariate analysis demonstrated that acute myocardial infarction was an independent predictor for the risk of the development of AKI (Odd ratio 5.8, 95%CI 1.1-31.3, P = 0.04).
|Predictive factors of U-NGAL elevation|
|P value||Odd ration||95%CI||p value|
|Acute myocardial infarction||0.03||5.3||1.1-31.3||0.04|
|Age ( increased 1 year )||0.0002|
The elevation of U-NGAL levels is able to detect the development of AKI at immediately after procedure. This simple urinary test may be useful tool to identify the risk of mortality.
OTHER: Renal Insufficiency and Contrast Nephropathy