Plasma Neutrophil Gelatinase-Associated Lipocalin Is Useful for Predicting Mortality in Critically Ill Patients

Abstract

Elevated neutrophil gelatinase-associated lipocalin (NGAL) occurs in a wide range of systemic diseases. This study examined the clinical utility of plasma NGAL to predict intensive care unit (ICU) and in-hospital mortality in critically ill patients. A total of 62 patients hospitalized in a mixed ICU were included; pNGAL, creatinine, and C-reactive protein (CRP) were assayed on four consecutive days (D1-D4) following ICU admission. APACHE II score (Acute Physiology and Chronic Health Evaluation) was calculated 24 h post-admission. ICU mortality reached 35% and in-hospital mortality was 39%. The median pNGAL at admission was 142.5 (65.6–298.3) ng/mL. pNGAL was significantly higher in non-survivors compared to survivors. The highest accuracy for ICU mortality prediction was achieved at the pNGAL cutoff of 93.91 ng/mL on D4 area under the curve (AUC) = 0.89; 95%CI 0.69–0.98 and for in-hospital mortality prediction was achieved at the pNGAL cutoff of 176.64 ng/mL on D3 (AUC = 0.86; 95%CI 0.69–0.96). The APACHE II score on ICU admission predicted ICU mortality with AUC = 0.89 (95%CI 0.79–0.96) and in-hospital mortality with AUC = 0.86 (95%CI 0.75–0.94). Although pNGAL on D1 poorly correlated with APACHE II (R = 0.3; p = 0.01), the combination of APACHE II and pNGAL on D1 predicted ICU mortality with AUC = 0.90 (95%CI 0.79–0.96) and in-hospital mortality with AUC = 0.95 (95%CI 0.78–0.99). Maximal CRP during study observation failed to predict ICU mortality (AUC = 0.62; 95%CI 0.49–0.74), but helped to predict in-hospital mortality (AUC = 0.67; 95%CI 0.54–0.79). Plasma NGAL with combination with the indices of critical illness is a useful biomarker for predicting mortality in heterogeneous population of ICU patients.

Effect of dietary fiber on gut barrier function, gut microbiota, short‐chain fatty acids, inflammation, and clinical outcomes in critically ill patients: A systematic review and meta‐analysis

“…32 Although one study conducted in the mixed ICU found that CRP level measured at discharge was not a predictor of readmission or death, 29 other studies showed that CRP concentration in plasma is significantly correlated with mortality predictors in the ICU, especially in patients diagnosed with sepsis. 51,52 The predictive value (area under the curve) of CRP at admission for mortality was 0.576 in critically ill patients. 53 In this study, we found that the maximum level of CRP concentration in plasma on the 14th day of admission in the group with fiber supplement was significantly lower than that in the group without a fiber supplement, indirectly indicating that fiber supplement can reduce the inflammation status, which may be beneficial in improving mortality in critically ill patients.…”

“…CRP is an acute‐phase reactant, as a response to IL‐6, that can be detected in several types of inflammation and also in bacterial infection, and it is a measure that helps in the diagnosis of bacterial infection 32 . Although one study conducted in the mixed ICU found that CRP level measured at discharge was not a predictor of readmission or death, 29 other studies showed that CRP concentration in plasma is significantly correlated with mortality predictors in the ICU, especially in patients diagnosed with sepsis 51,52 . The predictive value (area under the curve) of CRP at admission for mortality was 0.576 in critically ill patients 53 .…”

Renal and Inflammation Markers—Renalase, Cystatin C, and NGAL Levels in Asymptomatic and Symptomatic SARS-CoV-2 Infection in a One-Month Follow-Up Study

“…The accuracy of NGAL both in urine and plasma appeared to improve as patients progressed through their ICU stay. The authors suggested that serial measurements of NGAL may be of added value in an ICU setting to predict AKI occurrence in critically ill patients [ 29 , 30 , 31 ]. Moreover, plasma NGAL levels evaluated at ICU admission predict acute kidney injury in adult patients [ 32 ], with additional accuracy when analyzed together with eGFR [ 33 ].…”

Predictive value of the serum anion gap for 28-day in-hospital all-cause mortality in sepsis patients with acute kidney injury: a retrospective analysis of the MIMIC-IV database

“…A previous study has conducted in-depth analyses of biomarkers related to SA-AKI, demonstrating that the plasma neutral gelatin associated lipocalin (pNGAL) level at discharge can predict the recovery potential of renal function in SA-AKI patients ( 20 ). A recent study showed that pNGAL can predict the risk of death of critically ill patients during hospitalization and ICU stay ( 21 ). However, for SA-AKI patients, it is unclear whether pNGAL can predict the risk of death.…”