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Effect of goal-directed therapy on post-operative neutrophil gelatinase-associated lipocalin profile in patients undergoing on-pump coronary artery surgery

  • Poonam Malhotra Kapoor
  • Ameya Karanjkar
  • Rohan Magoon
  • Sameer Taneja
  • Sambhunath Das
  • Vishwas Malik
  • Ujjwal Kumar Chowdhury
  • Vajala Ravi
Original Article
  • 11 Downloads

Abstract

Purpose

Neutrophil gelatinase-associated lipocalin (NGAL) is an early biomarker of acute kidney injury (AKI). Goal-directed therapy (GDT) in on-pump coronary artery bypass grafting (CABG) has been associated with lower post-operative NGAL levels in recent studies. The present study aimed at comparing plasma (P) and urinary (U)-NGAL levels following the use of GDT versus conventional haemodynamic therapy (CT) in patients undergoing on-pump CABG.

Methods

A prospective randomised controlled study conducted in a single university hospital. A total of 54 patients in the GDT group and 56 patients in CT group after exclusions.

Results

U-NGAL was significantly lower immediately post-surgery (T1) in GDT group (25.11 ± 1.5 versus 27.80 ± 1.7 μg/L; p < 0.001) and at 4 h (T2) (38.19 ± 23.6 versus 52.30 ± 28.3 μg/L; p = 0.006) and at 24 h post-operatively (T3) (34.85 ± 14 versus 39.7 ± 11.1 μg/L; p = 0.047). P-NGAL was comparable between groups at T1 but lower in the GDT group at T2 (92.81 ± 4.8 versus 94.77 ± 4.5 μg/L; p = 0.03) and T3 (67.44 ± 3.7 versus 75.96 ± 5.3 μg/L; p < 0.001). U-NGAL levels correlated well with the peak post-operative creatinine as compared to P-NGAL. On-pump patients manifest neutrophil activation, accounting for comparable levels of P-NGAL in the two groups at T1. GDT-based haemodynamic management resulted in lower U-NGAL levels at T1, T2 and T3 and lower P-NGAL levels at T2 and T3.

Conclusions

Haemodynamic optimisation with GDT prevents further renal insult initiated with the inflammatory activation with cardiopulmonary bypass (CPB), as evidenced by lower post-operative U-NGAL levels.

Keywords

Acute kidney injury Cardiopulmonary bypass Goal-directed therapy 

Notes

Compliance with ethical standards

All procedures performed in this study on human participants were in accordance with the ethical standards of the institutional ethics committee of All India institute of Medical Sciences, New Delhi, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  1. 1.Department of Cardiac Anaesthesia, Cardiothoracic Centre, CNCAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Cardiothoracic and Vascular SurgeryAll India Institute of Medical SciencesNew DelhiIndia
  3. 3.Lady Shri Ram CollegeUniversity of DelhiNew DelhiIndia

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