Abstract: FR-PO0387
Overcoming the Creatinine Lag: Superior Predictive Power of 12-Hour Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecular-1 (KIM-1), and IL-18 for AKI After Coronary Artery Bypass Grafting
Session Information
- AKI: Biomarkers, Diagnostics, and Risk Prediction
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Malik, Manish, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Chauhan, Sushant K., Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Malik, Navya Naomi, School of Medicine, St. George’s University, Grenada, Grenada
- Jaiswal, Akhilesh, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Kumar, Tarun, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Saha, Rajdeb, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Tiwari, Vaibhav, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Bhargava, Vinant, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Gupta, Anurag, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Gupta, Ashwani, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Bhalla, Anil, Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
- Rana, Devinder S., Sir Ganga Ram Hospital Department of Nephrology, New Delhi, DL, India
Background
Acute kidney injury (AKI) is a severe complication of coronary artery bypass grafting (CABG) associated with increased morbidity. Diagnosis conventionally relies on serum creatinine (SCr), which introduces a 24- to 72-hour diagnostic lag because it rises only after a significant portion of nephron mass is compromised. This study evaluated the predictive ability of novel urinary biomarkers NGAL, KIM-1, and Interleukin-18 (IL-18) measured 12 hours postoperatively for early AKI detection in CABG patients.
Methods
A prospective observational study included 100 adult patients with normal baseline renal function undergoing planned CABG at a tertiary center. Urinary NGAL, KIM-1, and IL-18 levels were measured 12 hours postoperatively using ELISA. Patients were monitored for AKI development over 72 hours based on KDIGO criteria. Diagnostic performance was evaluated via ROC curve analysis to determine the Area Under the Curve (AUC), optimal cut-offs, sensitivity, and specificity.
Results
The study population had a mean age of 61.71 ± 9.67 years and was predominantly male (90%). Postoperative AKI developed in 29% of patients. AKI patients had significantly longer hospital stays compared to those without AKI (9.69 ± 2.96 vs. 7.36 ± 1.72 days; p=0.004). At 12 hours postoperatively, all three biomarkers were significantly elevated in the AKI group versus the non-AKI group: NGAL (15.82 ± 24.12 vs. 1.59 ± 2.50 ng/mL, p=0.002), KIM-1 (1906.3 ± 1865.96 vs. 239.71 ± 818.92 pg/mL, p=0.001), and IL-18 (79.19 ± 94.25 vs. 23.97 ± 45.35 pg/mL, p=0.004). ROC analysis demonstrated excellent diagnostic performance. NGAL exhibited the highest discriminative ability with an AUC of 0.929 (cut-off 2.05 ng/mL; sensitivity 86.2%, specificity 81.4%), followed by IL-18 (AUC 0.884; cut-off 25.40 pg/mL; sensitivity 89.7%, specificity 77.1%), and KIM-1 (AUC 0.873; cut-off 58.0 pg/mL; sensitivity 89.7%, specificity 65.7%). Biomarker levels lacked correlation with baseline SCr, reflecting acute structural tubular injury independent of baseline renal status.
Conclusion
Urinary NGAL, KIM-1, and IL-18 measured 12 hours postoperatively are highly sensitive and specific early predictors of AKI in CABG patients. Their rise precedes standard SCr changes, providing a crucial window for timely nephroprotective interventions to improve overall patient outcomes.