Association of plasma and urine NGAL with acute kidney injury after elective colorectal surgery: A cohort study

BACKGROUND: Acute kidney injury (AKI) is common in surgical patients. We aimed to investigate the validity of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in the detection of AKI and prediction of outcomes in patients undergoing major colorectal surgery. MATERIALS AND METHODS: This was a pre-specified post-hoc analysis of a randomized controlled trial comparing oesophageal doppler and Lithium dilution cardiac output monitoring in high risk patients undergoing major colorectal surgery as part of an Enhanced Recovery After Surgery protocol in a tertiary care hospital. Plasma and urine samples for NGAL measurement were taken before surgery (T1), immediately after surgery (T2), and on postoperative day 1 (T3). AKI was defined according to the KDIGO criteria. RESULTS: A total of 89 patients were included of whom 12 (13.5%) developed AKI. Plasma NGAL significantly increased from T1 to T3 in both AKI (p < 0.001) and non-AKI (p = 0.048) patients, while urine NGAL did not change over time. There were no significant differences in plasma and urine NGAL in patients with and without AKI at all time points. Postoperative day 1 urine NGAL concentrations were significantly higher in non-survivors than survivors (41.2 versus 25 ng/mL, p = 0.026). One-year mortality was significantly higher in AKI patients with a raised urine NGAL compared to AKI patients without elevated urine NGAL levels. CONCLUSIONS: Plasma and urine NGAL poorly predicted AKI post-colorectal surgery. Non-survivors had higher urine NGAL results. More research is required to explore the association between NGAL and long-term outcomes.