Enhanced detection of cardiac surgery-associated acute kidney injury by composite biomarker panel in patients with normal preoperative kidney function

We have shown recently that minor subclinical creatinine dynamic changes enable excellent de-tection of acute kidney injury (AKI) within 6-12 hours after cardiac surgery. The aim of the pre-sent study was to examine combination of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine for enhanced AKI detection early after cardiac surgery. Elective patients with normal renal function undergoing cardiac surgery using cardiopulmonary bypass were enrolled. Concentrations of plasma NGAL, serum CysC and serum creatinine concentra-tions were determined after induction of general anaesthesia, at termination of cardiopulmo-nary bypass and 2 hours thereafter. Out of 119 enrolled patients 51 (43%) developed AKI. A model utilizing NGAL, CysC and creatinine triple biomarker panel including sequential rela-tive changes provides better prediction of cardiac surgery-associated acute kidney injury then any biomarker alone already 2 hours after the termination of cardiopulmonary bypass. The area under receiver-operator curve was 0.77, sensitivity 77% and specificity 68%.