Association of peripheral blood neutrophil gelatinase‐associated lipocalin levels with bone marrow neutrophil gelatinase‐associated lipocalin levels and neutrophil count in hematologic malignancy

Abstract

BackgroundAlthough neutrophil gelatinase‐associated lipocalin (NGAL) is a biomarker for acute kidney injury, recently, high NGAL levels have been reported in hematologic malignancies. Given the mechanism underlying NGAL synthesis and secretion in neutrophilic series, it is speculated that NGAL levels are higher in bone marrow (BM) than in peripheral blood (PB). Additionally, PB NGAL levels are thought to be associated with neutrophilic parameters. We aimed to test both hypotheses in hematologic malignancies.MethodsPaired BM and PB samples were collected from 41 patients undergoing BM examination for hematologic malignancies. NGAL levels were measured using immunoassays. Data on hematologic parameters were collected from medical records. Single and multiple regression analyses were performed to analyze the relationship.ResultsPB and BM NGAL (n = 41) levels were significantly different (163.0 ± 258.3 and 413.1 ± 616.2 ng/mL [mean ± standard deviation], respectively; P < 0.05). Simple regression analysis and multicollinearity assessment showed that BM NGAL levels, BM neutrophil%, and neutrophil count were significant predictors of PB NGAL. Two multiple regression models were developed (model 1, PB NGAL = 21.467* neutrophil count ‐ 0.785*BM neutrophil%; model 2, PB NGAL = 21.202*neutrophil count‐ 0.915*BM neutrophil% +0.10*BM NGAL). Akaike's information criterion and adjusted R 2 values showed that model 1 had higher predictive accuracy for PB NGAL. In both models, neutrophil count was the only significant predictor.ConclusionBM NGAL was significantly higher than PB NGAL in hematologic malignancy. In addition, PB NGAL could be expressed as a multiple regression model including neutrophil count and BM neutrophil%, being significantly influenced by neutrophil count.

Analysis of bone marrow supernatant neutrophil gelatinase‐associated lipocalin and hematological parameters in hematological malignancy

“…9 Another study reported that the level of BM NGAL was significantly higher than that of PB NGAL in individuals with hematological malignancy, suggesting that BM NGAL would reflect the BM microenvironment better than PB NGAL. 10 Hematological malignancy develops in the BM, while neutrophilic precursors as the major source of NGAL synthesis exist mostly in the BM. 5 Accordingly, the accurate analysis of NGAL according to the hematological malignancy requires the measurement of BM NGAL rather than PB NGAL.…”

“…5 Accordingly, the accurate analysis of NGAL according to the hematological malignancy requires the measurement of BM NGAL rather than PB NGAL. 10 Meanwhile, the PB NGAL level was reported to show a statistically significant association with the neutrophil count. Hence, BM NGAL might also show a significant relation with the neutrophil count; however, further study is warranted to confirm this speculation.…”

“…Hence, BM NGAL might also show a significant relation with the neutrophil count; however, further study is warranted to confirm this speculation. 10 This study aimed to measure the NGAL levels in BM samples of patients who underwent BM examination for the diagnosis of hematological malignancies and evaluate whether BM NGAL has a significant association with hematological parameters including neutrophil count. In addition, we aimed to compare the NGAL levels in patients with AML, myelodysplastic syndrome (MDS), myeloid proliferative neoplasm (MPN), and plasma cell neoplasm (PCN) with those in control.…”

Analysis of the diagnostic capabilities of urinary neutrophil gelatinase‐associated lipocalin and serum procalcitonin for acute kidney injury at the early stage of critical care intensive care unit admission

“…NGAL measurements may be influenced by several coexisting variables such as chronic kidney disease, hypertension, systemic infections, inflammatory conditions, anemia, hypoxia, and malignancies 24–28 . In the critical care ICU, patients with septic AKI have the highest levels of both plasma and urine NGAL compared with those of patients with non‐septic AKI, which can increase the heterogeneity of results 21,29,30 …”

“…NGAL measurements may be influenced by several coexisting variables such as chronic kidney disease, hypertension, systemic infections, inflammatory conditions, anemia, hypoxia, and malignancies. 24 , 25 , 26 , 27 , 28 In the critical care ICU, patients with septic AKI have the highest levels of both plasma and urine NGAL compared with those of patients with non‐septic AKI, which can increase the heterogeneity of results. 21 , 29 , 30 The variable performance of biomarkers such as NGAL in the critical care setting may also be because this patient population is extremely heterogeneous, and the etiology and timing of AKI is often unclear.…”