214 - Use of Urine Neutrophil Gelatinase-Associated Lipocalin for Prediction of Severe and Persistent Acute Kidney Injury in Children after Cardiac Surgery

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 214
Publication Number: 214.203

Katherine Melink, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kevin Pettit, University of Colorado / Children's Hospital Colorado, Denver, CO, United States; Emily Sullivan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katja M. Gist, Children's Hospital Medical Center (Cincinnati), Cincinnati, OH, United States; Natalja L. Stanski, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Presenting Author(s)

Katherine Melink, MD (she/her/hers)

Resident Physician
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Background: Acute kidney injury (AKI) is common in critically ill children and associated with poor outcomes, especially when severe and persistent. Children admitted following cardiac surgery are at high risk for AKI in the early post-operative period, but limited tools exist to predict which patients will develop severe and/or persistent AKI. Urine neutrophil gelatinase-associated lipocalin (uNGAL) may be useful to identify these patients early.

Objective: We aimed to evaluate the predictive ability of uNGAL for both (1) the presence of day 2-4 severe AKI following cardiac surgery, and (2) the persistence of AKI in children with early post-operative AKI.

Design/Methods: A single-center prospective observational study of children aged 0 to 18 years admitted to the cardiac intensive care unit (CICU) after cardiac surgery. uNGAL was measured within 12 hours of surgery. The primary outcomes were (1) severe day 2-4 AKI (≥KDIGO Stage 2) and (2) severe persistent AKI (defined as early [post-operative days 0-1] serum creatinine-based AKI that persists for ≥48 and is ≥KDIGO Stage 2 by post-operative day 2-4).

Results: Among 377 patients, 29 (7.7%) had day 2-4 severe AKI. Compared to those without, patients with severe AKI experienced longer durations of cardiopulmonary bypass (CPB) (149 vs 128 minutes), longer CICU stays (11 vs 3 days), longer mechanical ventilation (2.8 vs 1 day) and increased mortality (24% vs 3.2%) (Table 1). On multivariate logistic regression, early AKI (aOR 8.6, 95%CI 3.6-21, p< 0.001) and uNGAL >150 ng/ml (aOR 2.5, 95%CI 1.02-6.1, p=0.045) retained associations with day 2-4 severe AKI. Regardless of early AKI status, uNGAL predicted day 2-4 severe AKI with an AUC of 0.64 (95%CI 0.53-0.75, p=0.013), with sensitivity 47% (95% CI 29-65%), specificity 80% (76-84%), PPV 17% (95% CI10-27%) and NPV 95% (91-97%). Thirty-seven patients (10%) had early AKI, and 13/37 (35%) had severe persistent AKI. Compared to those without, patients with severe persistent AKI had longer CPB durations (206 vs 149 minutes), longer CICU stays (6 vs 3.5 days), longer mechanical ventilation (2.9 vs 1.8 day) and increased mortality (31% vs 0%) (Table 2).

Conclusion(s):

Children admitted to the CICU following cardiac surgery who develop severe and/or persistent AKI suffer worse outcomes, including higher rates of mortality, compared to those who do not. In this cohort, uNGAL was modestly predictive of day 2-4 severe AKI, with high NPV using a threshold of 150 ng/ml. Further study in a larger cohort is needed to examine its predictive value for severe persistent AKI.