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Abstract: PO2285

Post-Operative Fluid Overload Is Associated with AKI and Elevated Urinary Neutrophil Gelatinase-Associated Lipocalin Values

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Slagle, Cara L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Gavigan, Hailey Woollen, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Rowe, James A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Poindexter, Brenda, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Schmerge, Alexandra, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Kotagal, Meera, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Ehrlich, Shelley, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Liu, Chunyan, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Positive fluid accumulation (FO) in neonates is associated with increased morbidity and mortality and may represent underlying acute kidney injury (AKI). AKI defined by changes in serum creatinine (SCr) and urine output (UOP) can be unreliable in the setting of FO. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) offers promise as an alternative biomarker in assessing AKI in patients with FO.

Methods

Infants undergoing a general surgical procedure, excluding gastric tube placement alone, were prospectively enrolled. uNGAL values were obtained pre-op and on post-op days (0-3) at six time points. FO was defined as 10% weight increase from pre-op weight during PODs 0-5. Percent FO was calculated using post-op net fluid balance(L)/pre-op weight(kg)x100. Adjusted SCr was calculated by SCrx(1+[Net fluid balance post-op(L)/(0.8*Pre-op weight(kg))]). Associations between uNGAL values and post-op FO and no FO groups were evaluated by Mann-Whitney U tests. Ability to predict FO was assessed by receiver operating characteristic curves (AUC-ROC).

Results

A total of 141 infants underwent 192 procedures. FO occurred after 46% (88/192) procedures (mean %FO = 27±10). Previous medical history of AKI was associated with development of post-op FO (35% vs. 14%, p=<0.001). Development of post-op AKI was also associated with FO even when controlled for pre-op AKI (69% vs. 31%, p=0.005). When SCr was adjusted for FO, AKI increased from 35 to 38 events and stage of AKI increased in 8 events. In FO patients, elevations in uNGAL were higher at all time points (Table 1). The AUC-ROC for uNGAL to predict post-op FO was 0.7 (95% CI: 0.63-0.78).

Conclusion

FO is an indicator of reduced renal function and is associated with AKI. uNGAL offers utility as an additional biomarker to assist in prediction of post-op FO and inability to maintain acceptable fluid balance. Post-op FO should be monitored closely for in all surgical patients, and particularly patients with a previous history of AKI.

Median [IQR] uNGAL values in FO and non FO patients
 Pre-op uNGAL (ng/mL)12 hour uNGAL
(ng/mL)
24 hour uNGAL
(ng/mL)
36 hour uNGAL
(ng/mL)
48 hour uNGAL
(ng/mL)
72 hour uNGAL
(ng/mL)
96 hour uNGAL
(ng/mL)
All (n=125)(n=163)(n=175)(n=172)(n=170)(n=172)(n=154)
FO
(n=88)
48 [9, 128]95 [17, 699]150 [25, 501]132 [25, 593]100 [18, 603]56 [20, 276]72 [23, 213]
No FO
(n=104)
24 [9, 89]24 [10,49]28 [10, 120]36 [14, 86]32 [12, 106]30 [12, 79]31 [11, 78]
p value0.1106<0.0001<0.0001<0.00010.00030.0060.0018

Funding

  • NIDDK Support