Cystatin C and neutrophil gelatinase-associated lipocalin: biomarkers for acute kidney injury after congenital heart surgery

Swiss Med Wkly. 2013 Jan 17;143:w13744. doi: 10.4414/smw.2013.13744. eCollection 2013.


Questions under study: To evaluate the diagnostic value of serum Cystatin C and urine neutrophil gelatinase-associated lipocalin (NGAL) for the detection of acute kidney injury in patients undergoing congenital heart surgery.

Methods: Serial samples of serum Cystatin C and urine NGAL were collected from 139 consecutive patients with congenital heart defects aged 3 days to 30 years after admission to the intensive care unit, 2 and 6 hours after the end of cardiopulmonary bypass. Biomarker levels were compared to perioperative data retrospectively. Acute kidney injury was defined according to the paediatric-modified RIFLE classification.

Results: According to the paediatric-modified RIFLE criteria 53% of patients developed evidence of acute kidney injury. Serum Cystatin C concentrations were strongly correlated with severity of acute kidney injury. Optimal sensitivity of 80% and specificity of 66% for the prediction of acute kidney injury occurred at a cut-off value of 0.995 mg/l, 2 hours after the end of cardiopulmonary bypass. The 2 hour urine NGAL concentration was significantly correlated to the duration of cardiopulmonary bypass, time of aortic cross clamping, and serum lactate concentration. Moreover a significant correlation was found between urine NGAL and both length of hospital stay and mechanical ventilation.

Conclusions: In patients after congenital heart surgery, urine NGAL indicates the damaging force of cardiopulmonary bypass and serum Cystatin C is a valuable predictive biomarker for resulting acute kidney injury.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Kidney Injury / diagnosis*
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / metabolism*
  • Acute-Phase Proteins / urine*
  • Adolescent
  • Adult
  • Area Under Curve
  • Biomarkers / blood
  • Biomarkers / urine
  • Cardiopulmonary Bypass / adverse effects
  • Child
  • Child, Preschool
  • Creatinine / blood
  • Cystatin C / blood*
  • Female
  • Heart Defects, Congenital / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Lipocalin-2
  • Lipocalins / urine*
  • Male
  • Predictive Value of Tests
  • Proto-Oncogene Proteins / urine*
  • ROC Curve
  • Severity of Illness Index
  • Young Adult


  • Acute-Phase Proteins
  • Biomarkers
  • Cystatin C
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Proto-Oncogene Proteins
  • Creatinine