Predictive value of serum and urinary neutrophil gelatinase-associated lipocalin in the early detection of acute kidney injury after major abdominal surgery

This study aimed to evaluate the predictive abilities of both serum neutrophil gelatinase-associated lipocalin (sNGAL) and urinary neutrophil gelatinase-associated lipocalin (uNGAL) in the early detection of acute kidney injury (AKI) among patients undergoing major abdominal surgery. The study commenced after obtaining approval from the local ethics committee (12 January 2023; no. 1/22). This prospective observational study was conducted between June and November 2023. Patients undergoing elective major abdominal surgery were included. Their demographic and operation data were recorded. Four hours after surgery, serum and urine samples were collected for NGAL measurements. Additionally, serum samples for creatinine (sCr) measurements were obtained from patients before surgery and at 4, 12, 24 and 48 hours after surgery. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes guidelines based on changes in sCr levels over the first 48 hours postoperatively. The study included 43 patients, with AKI occurring in five individuals (11.6%). Four hours postoperatively, the sNGAL values were 77.5 ± 20.5 ng/mL in the non-AKI group and 281.3 ± 166.4 ng/mL in the AKI group. The uNGAL values were 256.1 ± 137.4 ng/mL and 539.7 ± 160 ng/mL, respectively. The areas under the curve (AUC) for sNGAL and uNGAL were 0.989 and 0.921, respectively. The optimal cut-off value for sNGAL was 121.9 ng/mL, resulting in 100% sensitivity and 94.7% specificity. For uNGAL, the optimal cut-off was 513.9 ng/mL, with a sensitivity of 80% and a specificity of 97.4%. To identify AKI after major abdominal surgery, using both sNGAL and uNGAL allows for earlier detection compared to diagnostic methods based on sCr.

Acute kidney injury; Major abdominal surgery; Neutrophil gelatinase-associated lipocalin

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