Evidence map›Paper›PMID 34028701›Full record

Observational studyJournal of nephrology2022

NGAL/hepcidin-25 ratio and AKI subtypes in patients following cardiac surgery: a prospective observational study.

Saban Elitok, Prasad Devarajan, Rinaldo Bellomo, Berend Isermann, Michael Haase, Anja Haase-Fielitz

Registry-linked trialOpen access · hybridAbstract readObservational Study
In one paragraph

Observational study in Journal of nephrology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00672334 (A Multicenter, Randomized, Double Blind, Placebo Controlled Study of the Effect of Sodium Bicarbonate on Postoperative Renal Function in Patients Undergoing Elective Cardiopulmonary Bypass), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
0.3field-weighted citation impact, top 46% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00672334 phase2 / phase3terminatednot on this map

A Multicenter, Randomized, Double Blind, Placebo Controlled Study of the Effect of Sodium Bicarbonate on Postoperative Renal Function in Patients Undergoing Elective Cardiopulmonary Bypass

TypeinterventionalSponsorAustin HealthRan2008 to 2012Enrolled350ConditionsCardiac Surgery, Cardiopulmonary BypassArmsSodium Bicarbonate, Sodium Chloride
3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 6 institutions in 3 countries.

Saban ElitokDepartment of Nephrology and Endocrinology, Ernst Von Bergmann Hospital Potsdam, 14467, Potsdam, Germany.ORCID http://orcid.org/0000-0002-1195-6871
Prasad DevarajanDepartment of Nephrology and Hypertension, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA.ORCID http://orcid.org/0000-0002-7847-8552
Rinaldo BellomoDepartment of Intensive Care, Royal Melbourne Hospital, Parkville, Melbourne, VIC, 3052, Australia.ORCID http://orcid.org/0000-0002-1650-8939
Berend IsermannInstitute of Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostic, Leipzig University Hospital, 04103, Leipzig, Germany.ORCID http://orcid.org/0000-0003-0714-6160
Michael HaaseDiaverum AB, Renal Care Center Potsdam, 21532, Malmö, Sweden. michael.haase@med.ovgu.de.ORCID http://orcid.org/0000-0001-8212-7416
Anja Haase-FielitzBrandenburg Medical School Theodor Fontane, 16816, Neuruppin, Germany.ORCID http://orcid.org/0000-0001-6881-2249
Cincinnati Children's Hospital Medical Center · USKlinikum Ernst von Bergmann · DEOtto-von-Guericke-Universität Magdeburg · DEThe Royal Melbourne Hospital · AUUniversity Hospital Leipzig · DEUniversity of Applied Sciences Potsdam · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAcute kidney injury (AKI) subtypes combining kidney functional parameters and injury biomarkers may have prognostic value. We aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL)/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of hepcidin-25) defined subtypes are of prognostic relevance in cardiac surgery patients.

methodsWe studied 198 higher-risk cardiac surgery patients. We allocated patients to four groups: Kidney Disease Improving Global Outcomes (KDIGO)-AKI-negative and NGAL/hepcidin-25 ratio-negative (no AKI), KDIGO AKI-negative and NGAL/hepcidin-25 ratio-positive (subclinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-negative (clinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-positive (combined AKI). Outcomes included in-hospital mortality (primary) and long-term mortality (secondary).

resultsWe identified 127 (61.6%) patients with no AKI, 13 (6.6%) with subclinical, 40 (20.2%) with clinical and 18 (9.1%) with combined AKI. Subclinical AKI patients had a 23-fold greater in-hospital mortality than no AKI patients. For combined AKI vs. no AKI or clinical AKI, findings were stronger (odds ratios (ORs): 126 and 39, respectively). After adjusting for EuroScore, volume of intraoperative packed red blood cells, and aortic cross-clamp time, subclinical and combined AKI remained associated with greater in-hospital mortality than no AKI and clinical AKI (adjusted ORs: 28.118, 95% CI 1.465-539.703; 3.737, 95% CI 1.746-7.998). Cox proportional hazard models found a significant association of biomarker-informed AKI subtypes with long-term survival compared with no AKI (adjusted ORs: pooled subclinical and clinical AKI: 1.885, 95% CI 1.003-3.542; combined AKI: 1.792, 95% CI 1.367-2.350).

conclusionsIn the presence or absence of KDIGO clinical criteria for AKI, the urinary NGAL/hepcidin-25-ratio appears to detect prognostically relevant AKI subtypes. TRIAL REGISTRATION NUMBER: NCT00672334, clinicaltrials.gov, date of registration: 6th May 2008, https://clinicaltrials.gov/ct2/show/NCT00672334 . Definition of AKI subtypes: subclinical AKI (KDIGO negative AND Ratio-positive), clinical AKI (KDIGO positive AND Ratio-negative) and combined AKI (KDIGO positive AND Ratio-positive) with urinary NGAL/hepcidin-25 ratio-positive cut-off at 85% specificity for in-hospital death. AKI, acute kidney injury. AUC, area under the curve. NGAL, neutrophil gelatinase-associated lipocalin. KDIGO, Kidney Disease Improving Global Outcomes Initiative AKI definition.

Indexed as

Acute Kidney InjuryCardiac Surgical ProceduresBiomarkersHepcidinsHospital MortalityHumansLipocalin-2BiomarkersHepcidinsLipocalin-2Cardiopulmonary bypassCardiorenal syndromeNGAL/hepcidin-25 ratioSubclinical AKI

Identifiers

PMID34028701
PMCPMC8926978
OpenAlexW3165264135

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.