Abstract: SA-PO078

Efficacy of Urinary Output for the Early Diagnosis and Urinary NGAL for the Prognosis of AKI after Major Elective Non-Vascular Abdominal Surgeries

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Souza, Graziela Ramos barbosa de, São Paulo University, São Paulo, Brazil
  • Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
  • Marçal, Lia Junqueira, UNIVERSIDADE DE SAO PAULO, Sao Paulo - SP, Brazil
  • Yu, Luis, University of Sao Paolo School of Medicine, Sao Paulo, Brazil
  • Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
Background

Data comparing the efficacy of urinary output (UO) and serum creatinine (SCr) changes using RIFLE and KDIGO AKI definitions after major elective non-vascular abdominal surgeries (MENVAS) are scarce. The role of urinary NGAL as an outcome predictor in these patients is unknown. The aims of this study are to compare the efficacy of RIFLE and KDIGO SCr and UO criteria for AKI diagnosis and the role of NGAL changes in the outcome of patients (pts) submitted to MENVAS admitted to the ICU.

Methods

One hundred and seventy one pts were prospectively evaluated, peri-operatively and from the ICU admission up to 7 days. SCr (mg/dl) was assessed before surgery and once a day up to 7 d or until ICU discharge. Hourly UO (ml/kg/h) was measured daily. AKI was diagnosed using either SCr or UO according RIFLE and KDIGO definitions. Urine samples were collected at the pre-operatory, at ICU admission, and 12 and 24 hours after ICU admission for NGAL (ng/mg urinary Cr) analysis. Data are presented as mean ± SD, median (minimal and maximum value) or frequency. Statistical significance was p<0.05.

Results

According to RIFLE criteria 101 pts (59.1%) developed AKI: 5 by SCr, 76 by UO and 20 by SCr+UO. Using KDIGO criteria 102 pts (60%) developed AKI: 6 by SCr, 67 by UO and 29 by SCr+UO. Pts with AKI diagnosed by UO, SCr and SCr+UO had, respectively, hospital length of stay (LoS) 19±19, 14±10 and 24±22 d (NS), ICU LoS of 3±1, 4±3 and 5±3 d (p<0.001 UO vs. SCr+UO) and mortality 4.5, 33.3 and 17.2%, respectively (p=0.0211). If the SCr criteria alone was utilized for AKI diagnosis, 25 pts in RIFLE group and 35 in the KDIGO group would be overlooked. Pts who died had higher NGAL values in the immediate post-surgery [108 (24-31642) vs. 45 (4–3763) no death, p=0.0085] and 24 h post-surgery [222 (59-8482) vs. 54 (3–6579) no death, p=0.0026] periods.

Conclusion

UO measurement seems to be pivotal for early AKI recognition, since the use of SCr criteria alone would miss a high number of AKI diagnoses, using either RIFLE or KDIGO definitions. Early NGAL increase after major elective non-vascular abdominal surgeries was associated with higher mortality in this group of patients.

Funding

  • Government Support - Non-U.S.