Plasma neutrophil gelatinase-associated lipocalin (NGAL) as an early predictive marker of contrast-induced nephropathy in hospitalized patients undergoing computed tomography

Abstract

BackgroundContrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI). Neutrophil gelatinase-associated lipocalin (NGAL) represents a promising biomarker for AKI. Its role in the early diagnosis of CIN has already been examined in adults and children undergoing coronary angiography. This study was designed to prospectively evaluate plasma NGAL compared with serum creatinine (SCr) for early CIN detection among hospitalized patients undergoing contrast-enhanced computed tomography (CT).MethodsWe prospectively enrolled consecutive hospitalized patients undergoing elective CT with intravenous (IV), low-osmolar contrast administration. Patients with pre-procedure SCr >150 μmol/L (1.7 mg/dL), congestive heart failure, haemodynamic instability, sepsis, or urinary tract infection were excluded. Plasma NGAL was measured using the standardized Triage® NGAL test (Biosite Incorporated, San Diego, CA, USA) at baseline and 6 h post-procedure. SCr, blood urea nitrogen (BUN), albumin and sodium (Na) were measured and eGFR MDRD4 was calculated at the same intervals, as well as at 24 and 48 h post-procedure. CIN was defined as an increase in SCr of >25% or >44 μmol/L (0.5 mg/dL) from baseline within 48 h post-procedure, in the absence of other obvious causes.ResultsForty-seven patients, male/female 27/20, median age 68 (31–88) years, 16/47 diabetics, with baseline SCr 91.94 ± 20.33 μmol/L (1.04 ± 0.23 mg/dL) and eGFR MDRD4 68.40 ± 18.22 mL/min/1.73 m2 were enrolled. A contrast volume of 120 mL (range 100–150 mL) was administered. CIN was found in four subjects (8.51%), but detection by SCr was only possible 24 h in 1 and 48 h post-procedure in three. In contrast, significant elevation of plasma NGAL was found at 6 h post-procedure in those with versus those without CIN (779.25 ± 361.49 versus 82.30 ± 40.64 ng/mL, P < 0.001). Using a cutoff value of 200 ng/mL, sensitivity, specificity and area under the receiver-operating characteristic (ROC) curve of 6-h plasma NGAL for CIN prediction were excellent (100, 100 and 1.00%, respectively). Subjects with CIN did not differ in baseline demographics, renal function and diabetes status compared with those without CIN. No differences in any variable were noted between diabetics and non-diabetics. Plasma NGAL at 6 h (R2 = 0.24, P < 0.001) was found to be an independent predictor of CIN.ConclusionsPlasma NGAL 6 h after contrast administration measured by the rapid, point-of-care Triage® NGAL test appears to be a useful biomarker in the early prediction of CIN among hospitalized patients undergoing elective contrast-enhanced CT. However, the small sample size and the very small number of CIN events are important limitations. In any case, according to our evaluation, CIN incidence in this well-controlled population underlines the importance of early detection by an adequate and simple procedure such as the 6-h plasma NGAL test.

Cystatin C, but not urinary or serum NGAL, may be associated with contrast induced nephropathy after

“…Haase et al (28) analyzed data from 191 patients in 3 studies and found that when urinary NGAL is measured within 6 hours after contrast medium administration, it has better sensitivity than serum creatinine alone for acute kidney injury detection. Moreover, recent studies and a meta-analysis have demonstrated the role of serum and urinary NGAL in the prediction of CIN (15,16,(29)(30)(31)(32)(33)(34)(35)(36) and, although this biomarker has also been reported to have a low sensitivity in predicting CIN in specific settings, such as ACS (37), a previous study also suggested that it can also predict the severity of CIN (38).…”

Aging Male Spontaneously Hypertensive Rat as an Animal Model for the Evaluation of the Interplay between Contrast-Induced Acute Kidney Injury and Cardiorenal Syndrome in Humans

“…In SHRs with CI-AKI, the area under the receiver operating characteristic curve (AUROC) value of NGAL is 0.73, which is accepted as a value of failure [6] . In contrast, in humans with CI-AKI, 4 of 8 studies showed an excellent value (0.93-1.0) [39][40][41][42] , 2 of 8 studies showed a good value of NGAL (0.83-0.84) [43,44], and 2 of 8 studies showed a poor value of NGAL (0.63-0.68) [29,45] . In CKD patients undergoing elective coronary angiography with contrast, postprocedural NGAL increases from baseline in each stage of CKD [46] .…”

Serum Neutrophil Gelatinase-Associated Lipocalin Levels In Early Detection Of Contrast-Induced Nephropathy

“…Thus, NGAL offers promise for the early diagnosis of CIN in the emergency department. Filiopoulos et al reported that NGAL level at the 6 th hour had a sensitivity and specificity of 100% [16]. Plasma NGAL has been reported to be a highly specific and objective marker for the diagnosis of ARF [17][18][19].…”

“…Laçin et al reported that NGAL level elevated at 24 th hour and tended to decrease by two days [9]. Filiopoulos et al reported that it can be used as an early marker of CIN [16]. Laçin et al reported that the groups with and without CIN did not differ with respect to serum NGAL levels [9].…”