Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients.
ABSTRACT Measured at intensive care unit admission (ICU), the predictive value of neutrophil gelatinase-associated lipocalin (NGAL) for severe acute kidney injury (AKI) is unclear.
To assess the ability of plasma and urine NGAL to predict severe AKI in adult critically ill patients.
Prospective-cohort study consisting of 632 consecutive patients.
Samples were analyzed by Triage immunoassay for NGAL expression. The primary outcome measure was occurrence of AKI based on Risk-Injury-Failure (RIFLE) classification during the first week of ICU stay. A total of 171 (27%) patients developed AKI. Of these 67, 48, and 56 were classified as RIFLE R, I, and F, respectively. Plasma and urine NGAL values at ICU admission were significantly related to AKI severity. The areas under the receiver operating characteristic curves for plasma and urine NGAL were for RIFLE R (0.77 ± 0.05 and 0.80 ± 0.04, respectively), RIFLE I (0.80 ± 0.06 and 0.85 ± 0.04, respectively), and RIFLE F (0.86 ± 0.06 and 0.88 ± 0.04, respectively) and comparable with those of admission estimated glomerular filtration rate (eGFR) (0.84 ± 0.04, 0.87 ± 0.04, and 0.92 ± 0.04, respectively). Plasma and urine NGAL significantly contributed to the accuracy of the "most efficient clinical model" with the best four variables including eGFR, improving the area under the curve for RIFLE F prediction to 0.96 ± 0.02 and 0.95 ± 0.01. Serial NGAL measurements did not provide additional information for the prediction of RIFLE F.
NGAL measured at ICU admission predicts the development of severe AKI similarly to serum creatinine-derived eGFR. However, NGAL adds significant accuracy to this prediction in combination with eGFR alone or with other clinical parameters and has an interesting predictive value in patients with normal serum creatinine.
Full-textDOI: · Available from: Hilde De Geus, May 28, 2015
SourceAvailable from: Yolanda B de Rijke[Show abstract] [Hide abstract]
ABSTRACT: Children admitted to a pediatric intensive care unit (ICU) are at high risk of developing acute kidney injury (AKI). Although used in clinical practice, serum creatinine (SCr) is insensitive for early diagnosing AKI. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are novel AKI biomarkers of which the performance in pediatric ICU patients is largely unknown. We aimed to characterize uNGAL and KIM-1 patterns in children following ICU admission and to assess their properties to identify children at risk for AKI development. From June 2010 until January 2014 we conducted a prospective observational cohort study of term-born children aged one day to one year on mechanical ventilation. Blood and urine samples were obtained every 6 to 12 hours up to 72 hours post-admission. Blood samples were assayed for SCr; urine samples for uNGAL and KIM-1. The RIFLE classification (Risk, Injury, or Failure as 150%, 200% or 300% of median SCr reference values) was used to define AKI. 100 children were included (80 survived). Median age at admission was 27.7 days (IQR 1.5-85.5); median duration of mechanical ventilation was 5.8 days (IQR 3.1-11.4). Thirty-five patients had evidence of AKI within the first 48 hours post-admission of whom 24 (69%) already had AKI when entering the ICU. uNGAL and KIM-1 concentrations in AKI peaked between 6 to 12 hours and 12 to 24 hours post-admission, respectively. The maximal ROC-AUC for uNGAL was 0.815 (95%CI 0.685-0.945, P-value < 0.001) at 0 to 6 hours post-admission. The discriminative ability of KIM-1 was moderate with a largest AUC of 0.737 (95%CI 0.628-0.847, P-value < 0.001) at 12 to 24 hours post-admission. At the optimal cut-off point (126 ng/mL), uNGAL concentration predicted AKI development correctly in 16 out of 19 (84%) children, up to 24 hours before a rise in SCr became apparent. Levels of uNGAL and KIM-1 increase in patients with AKI following ICU admission and peak at 6 to 12 hours and 12 to 24 hours, respectively. uNGAL seems a reliable marker for identifying children who will develop AKI 24 hours later.Critical care (London, England) 04/2015; 19(1):181. DOI:10.1186/s13054-015-0910-0
Clinical and investigative medicine. Médecine clinique et experimentale 04/2015; · 0.97 Impact Factor
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ABSTRACT: Acute kidney injury (AKI) during sepsis is common and underestimated. Plasma neutrophil gelatinase-associated lipocalin (plasma-NGAL) is discussed as new biomarker for AKI diagnosis, but during inflammation its function and diagnostic impact remain unclear. The association between plasma-NGAL and inflammatory markers in septic patients, but also in healthy controls and patients with chronic inflammation before and after either maximum exercise test or treatment with an anti-TNF therapy were investigated. In-vitro blood stimulations with IL-6, lipopolysaccharide, NGAL or its combinations were performed to investigate cause-effect-relationship. Plasma-NGAL levels were stronger associated with inflammation markers including IL-6 (Sepsis: r=0.785 P <0.001; chronic inflammation after anti-TNF: r=0.558 P <0.001), IL-8 (Sepsis: r=0.714 P <0.004; healthy controls after exercise r=0.786 P <0.028; chronic inflammation before anti-TNF: r=0.429 P <0.041) and IL-10 (healthy controls before exercise: r=0.791 P <0.028) than with kidney injury or function. Correlation to kidney injury or function was found only in septic patients (for creatinine: r= 0.906 P <0.001; for eGFR: r= -0.686 P =0.005) and in patients with rheumatic disease after anti-TNF therapy (for creatinine: r= 0.466 P <0.025). In stimulation assays with IL-6 and lipopolysaccharide plasma-NGAL was increased. Co-stimulation of lipopolysaccharide with plasma-NGAL decreased cellular injury ( P <0.05) and in trend IL-10 levels ( P =0.057). Septic mice demonstrated a significantly improved survival rate after NGAL treatment ( P <0.01). Plasma-NGAL seams to be strongly involved in inflammation. For clinical relevance, it might not only be useful for AKI detection during severe inflammation - indeed it has to be interpreted carefully within this setting - but additionally might offer therapeutic potential.PLoS ONE 04/2015; 10(4-4):e0124429. DOI:10.1371/journal.pone.0124429 · 3.53 Impact Factor