Online ISSN 2313-1519
Print    ISSN 1812-2892
Abstract - Influence of Intraoperative Factors to Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) Levels in Cardiac Surgery Patients
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Abduzhappar Gaipov, Daniyar Abishev, Saltanat Moldakhmetova, Natalya Kim, Assem Nogaibayeva, Mukhit Dossov, Bolat Bekishev, Adilzhan Albazarov, Nadezhda Popova, Saltanat Tuganbekova

The aim of our pilot study was to determine the relation between the intraoperative parameters and levels of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in patients after cardiac surgery.

Methods: Twenty four adult (mean age 55.3±11 years) patients with coronary heart diseases whom planned cardiac surgery were included to study. All patients had initially normal kidney function (GFR > 60 ml/min). Diabetic patients were excluded from the study. Clinical survey included assessment of kidney and heart functions, routine laboratory assays. uNGAL levels were tested at 2nd and 12th hours after conducted cardiac surgery. We investigated association between the intraoperative factors such as extracorporeal circuit (pump on) time, intraoperative blood loss, duration of surgical operation and level of uNGAL.

Results: General clinical characteristics of patients were followings: GFR 92±20.6 ml/min, Hb 13.4±1.8 g/dL, WBC 6.9 x103/mm3, left ventricle ejection fraction 53.8±8.4%. All patients received standard surgical and anesthesiological protocols during the cardiac operation. Mean extracorporeal circuit time and duration of operation were 93.2±42.1 and 184±47.1 minutes respectively, intraoperative blood loss calculated 205±47.8 ml. Urine NGAL levels at 2nd and 12th hours after cardiac surgery made up 68.5±90.6 (0.8 - 267.2) ng/ml and 20.4±21 (0.3 - 92.4) ng/ml respectively. Mean staying days in intensive care unit (ICU) were 2.79±6.4 (1 - 32) days. In result of cardiac surgery, two patients developed acute kidney injury (AKI), and one patient died in result of multiorgan dysfunction syndrome.

Urine NGAL of 2nd hour positively correlated with extracorporeal circuit time (r=0.625, p=0.001), duration of operation (r=0.576, p=0.003), intraoperative blood loss (r=0.60, p=0.002) and with ICU staying time (r=0.449, p=0.022), whereas there were no correlation of these parameters with serum creatinine levels. Development of AKI were related with extracorporeal circuit time (r=0.436, p=0.033).

CONCLUSIONS: Prolongation of extracorporeal circuit time and duration of operation as well as excessive intraoperative blood losses was associated with increased uNGAL levels. Extracorporeal circuit time has an indirect relationship with the risk of AKI in patients after cardiac surgery.

Volume 4, Number 30 (2013)