TY - JOUR
T1 - Association of perioperative plasma neutrophil gelatinase-associated lipocalin levels with 3-year mortality after cardiac surgery
T2 - A prospective observational cohort study
AU - TRIBE-AKI Consortium
AU - Moledina, Dennis G.
AU - Parikh, Chirag R.
AU - Garg, Amit X.
AU - Thiessen-Philbrook, Heather
AU - Koyner, Jay L.
AU - Patel, Uptal D.
AU - Devarajan, Prasad
AU - Shlipak, Michael G.
AU - Coca, Steven G.
AU - Raman, Jai
AU - Jeevanandam, Valluvan
AU - Akhter, Shahab
AU - Edelstein, Charles
AU - Passik, Cary
AU - Nagy, Judy
AU - Swaminathan, Madhav
AU - Chu, Michael
AU - Goldbach, Martin
AU - Guo, Lin Ruo
AU - McKenzie, Neil
AU - Myers, Mary Lee
AU - Novick, Richard
AU - Quantz, Mac
AU - Zappitelli, Michael
AU - Palijan, Ana
AU - Dewar, Michael
AU - Darr, Umer
AU - Hashim, Sabet
AU - Elefteriades, John
AU - Geirsson, Arnar
AU - Garwood, Susan
AU - Butrymowicz, Isabel
AU - Krumholz, Harlan
N1 - Funding Information:
Lead Author of the TRIBE AKI consortium : Chirag R. Parikh. Email: chirag.parikh@yale.edu . Section of Nephrology, Department of Medicine, Yale University School of Medicine, VA CT Healthcare System, and the Program of Applied Translational Research, New Haven, CT, USA. Members of TRIBE-AKI consortium : U of Chicago : Dr. Jai Raman, Dr. Valluvan Jeevanandam, Dr. Shahab Akhter. U of Colorado : Dr. Charles Edelstein. Danbury Hospital : Dr. Cary Passik, Ms. Judy Nagy. Duke University : Dr. Madhav Swaminathan. London, Ontario : Dr. Michael Chu, Dr. Martin Goldbach, Dr. Lin Ruo Guo, Dr. Neil McKenzie, Dr. Mary Lee Myers, Dr. Richard Novick, Dr. Mac Quantz. Montreal Children’s : Dr. Michael Zappitelli, Dr. Ana Palijan. Yale-New Haven : Dr. Michael Dewar, Dr. Umer Darr, Dr. Sabet Hashim, Dr. John Elefteriades, Dr. Arnar Geirsson, Dr. Susan Garwood, Dr. Isabel Butrymowicz, Dr. Harlan Krumholz. Additional Contributions: We thank Dr. Stephanie Dixon for her analytic support. This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.
Publisher Copyright:
© 2015, Public Library of Science. All rights reserved. This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2015/6/8
Y1 - 2015/6/8
N2 - Background: Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown. Methods: In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality. Results: During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Preoperative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04-2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0-1.7 and adjusted HR 1.78, 95% CI 1.2-2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79-1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87-1.61 for peak pNGAL). Conclusions: Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.
AB - Background: Higher levels of plasma neutrophil gelatinase-associated lipocalin (pNGAL) are an early marker of acute kidney injury and are associated with increased risk of short-term adverse outcomes. The independent association between pNGAL and long-term mortality is unknown. Methods: In this prospective observational cohort study, we studied 1191 adults who underwent cardiac surgery between 2007 and 2009 at 6 centers in the TRIBE-AKI cohort. We measured the pNGAL on the pre-operative and first 3 post-operative days and assessed the relationship of peri-operative pNGAL concentrations with all-cause mortality. Results: During a median follow-up of 3.0 years, 139 participants died (50/1000 person-years). Preoperative levels of pNGAL were associated with 3-year mortality (unadjusted HR 1.96, 95% CI 1.34,2.85) and the association persisted after adjustment for pre-operative variables including estimated glomerular filtration rate (adjusted HR 1.48, 95% CI 1.04-2.12). After adjustment for pre- and intra-operative variables, including pre-operative NGAL levels, the highest tertiles of first post-operative and peak post-operative pNGAL were also independently associated with 3-year mortality risk (adjusted HR 1.31, 95% CI 1.0-1.7 and adjusted HR 1.78, 95% CI 1.2-2.7, respectively). However, after adjustment for peri-operative changes in serum creatinine, there was no longer an independent association between the first post-operative and peak post-operative pNGAL and long-term mortality (adjusted HR 0.98,95% CI 0.79-1.2 for first pNGAL and adjusted HR 1.19, 95% CI 0.87-1.61 for peak pNGAL). Conclusions: Pre-operative pNGAL levels were independently associated with 3-year mortality after cardiac surgery. While post-operative pNGAL levels were also associated with 3-year mortality, this relationship was not independent of changes in serum creatinine. These findings suggest that while pre-operative pNGAL adds prognostic value for mortality beyond routinely available serum creatinine, post-operative pNGAL measurements may not be as useful for this purpose.
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U2 - 10.1371/journal.pone.0129619
DO - 10.1371/journal.pone.0129619
M3 - Article
C2 - 26053382
AN - SCOPUS:84936766189
SN - 1932-6203
VL - 10
JO - PloS one
JF - PloS one
IS - 6
M1 - e0129619
ER -