Value of urinary neutrophil gelatinase-associated lipocalin in early diagnosis of contrast-induced nephropathy in elderly coronary artery disease patients undergoing percutaneous coronary intervention / 中华老年医学杂志

ABSTRACT

Objective:To evaluate changes in urinary neutrophil gelatinase-associated lipocalin(NGAL)levels in elderly coronary artery disease(CAD)patients after percutaneous coronary intervention(PCI), and to explore the role of NGAL and its value in the early diagnosis of contrast-induced nephropathy(CIN).Methods:This was a retrospective case-control study.A total of 68 patients undergone PCI were consecutively enrolled between October 2012 and October 2013.Serum creatinine(SCr)was measured before and at 24, 48 and 72h after PCI.Urinary NGAL was measured before and at 2, 12 and 24 h after PCI.The value of urinary NGAL for early diagnosis of CIN was analyzed.Results:The overall incidence of CIN was 8.82%.Urinary NGAL levels at 2 h, 12 h and 24 h after PCI were higher than pre-surgery levels(all P<0.05). Compared with the non-CIN group, urinary NGAL levels were increased in the CIN group at 2 h, 12 h and 24 h after PCI(all P<0.05). Pearson correlation analysis showed that urinary NGAL levels at 2 h, 12 h and 24 h after PCI were positively correlated with peak SCr within 72 h after PCI( r=0.625、0.493, and 0.226, all P<0.05), and were negatively correlated with peak eGFR within 72 h after PCI( r=-0.732、-0.603 and -0.449, all P<0.05). The area under the receiver operating characteristic(ROC)curve(AUC)showed that urinary NGAL was 0.740(95% CI 0.481-0.998, P=0.029)at 2 h post-operation, and the sensitivity and specificity for the diagnosis of CIN were 62.5% and 73.3%, respectively, when the cut-off level was 17.52 ng/ml.The AUC of urinary NGAL was 0.948(95% CI 0.895-1.001, P<0.001)at 12 h post-operation, and the sensitivity and specificity for the diagnosis of CIN were 87.7% and 88.3%, respectively, when the cut-off level was 44.30 ng/ml.The AUC of urinary NGAL was 0.931(95% CI 0.869-0.994, P<0.001)at 24 h post-operation, and the sensitivity and specificity for the diagnosis of CIN were 86.2% and 73.3%, respectively, when the cut-off level was 48.65 ng/ml. Conclusions:Urinary NGAL can reflect acute kidney injury within 24 h of administration of contrast agents in coronary interventional therapy, and has a certain predictive value in the early diagnosis of CIN.