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Urinary neutrophil gelatinase-associated lipocalin-guided risk assessment for major adverse kidney events after open-heart surgery

    Christian Albert

    Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany

    Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany

    Diaverum Deutschland, Potsdam, BB, Germany

    ,
    Annemarie Albert

    Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany

    Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany

    Diaverum Deutschland, Potsdam, BB, Germany

    ,
    Rinaldo Bellomo

    School of Medicine, Intensive Care Unit, Austin Hospital, Heidelberg, VIC, 3084 Australia

    ,
    Siegfried Kropf

    Institute for Biometrics & Medical Informatics, Otto-von-Guericke University, Magdeburg, ST, Germany

    ,
    Prasad Devarajan

    Division of Nephrology & Hypertension, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA

    ,
    Sabine Westphal

    Institute of Laboratory Medicine, Hospital Dessau, Dessau, ST, Germany

    ,
    Hassina Baraki

    Department of Thoracic, Cardiac & Vascular Surgery, University of Göttingen, Göttingen, NI, Germany

    ,
    Ingo Kutschka

    Department of Thoracic, Cardiac & Vascular Surgery, University of Göttingen, Göttingen, NI, Germany

    ,
    Christian Butter

    Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany

    Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, BB, Germany

    ,
    Michael Haase

    Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany

    Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany

    Diaverum Deutschland, Potsdam, BB, Germany

    &
    Anja Haase-Fielitz

    *Author for correspondence:

    E-mail Address: a.haase-fielitz@immanuel.de

    Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany

    Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, BB, Germany

    Institute of Social Medicine & Health Economics, Otto-von-Guericke University, Magdeburg, ST, Germany

    Published Online:https://doi.org/10.2217/bmm-2018-0071

    Aim: To assess weather doctors’ clinical risk-assessment for major adverse kidney events (MAKE) and acute kidney injury (AKI) after open-heart surgery would improve when being informed about neutrophil gelatinase-associated lipocalin (NGAL) test result at ICU admission. Patients & Methods: Clinical risk-assessment for MAKE and AKI were performed with and without providing NGAL test result and compared in an exploratory- and a validation-cohort using reclassification metrics, exemplary category-free net reclassification improvement (cfNRI). Results: Exploratory cohort: doctors’ prediction of MAKE (cfNRI = 0.750 [0.130–1.370]; p = 0.018) and AKI (cfNRI = 0.565 [0.001–1.129]; p = 0.049) improved being provided with NGAL test information. This finding was confirmed in the validation-cohort (MAKE cfNRI = 0.930 [0.188–1.672]; p = 0.014) and the combined-cohort (MAKE: cfNRI = 0.847 [0.371–1.323], p < 0.001); AKI: cfNRI = 0.468 [0.099–0.836; p = 0.013]). Improvements mostly generated from correctly reclassifying patients who not developed events (p < 0.001). Conclusion: Biomarker informed risk-assessment is superior in predicting MAKE and AKI after open-heart surgery.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

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