Serum NGAL in Critically Ill Children in ICU from a Single Center in Egypt

Abstract

Introduction. The mortality and morbidity associated with acute kidney injury (AKI), unfortunately, remain unacceptably high. We aimed to detect the extent of serum neutrophil gelatinase-associated lipocalin (NGAL) to early detect AKI in critically ill children. Subjects and Methods. This is a case control study. It included 75 subjects that include 15 as controls and 60 critically ill children. Patients were further subdivided according to RIFLE criteria into two other categories: patients who developed AKI and patients who did not develop AKI. Serum NGAL assayed on admission and after 3 days. Results. There was significant increase in the level of NGAL among patients group when compared with control group. Also, 21.7% of children admitted to PICU developed AKI from which 8.3% needed dialysis. The receiver operating characteristic curve of NGAL at day 0 revealed AUC of 0.63 with 95% CI of 0.50–0.77. At a cutoff value of 89.5 ng/mL, the sensitivity of NGAL was 84.6%, while specifcity was 59.6%, positive predictive value was 36.7%, negative predictive value was 68.4%, and accuracy was 93.3% in diagnosis of AKI. Conclusion. We found that NGAL acts as a sensitive marker rather than a specific one for AKI. At the same time, it presents as a negative predictive value more valuable than being a positive predictive value in detecting AKI.

Role of urinary NGAL and microalbuminuria in the detection of subclinical acute kidney injury in pediatric intensive care unit and diabetic children

“…1 Serum creatinine values in critically ill children group showed no statistically significant difference when compared with controls. 18 These findings agree with Bailey et al who reported that there was a significant difference in serum NGAL between critically ill children and the control group. 19 Kari et al evaluated urinary NGAL in critically ill PICU children.…”

“…A a cutoff value of 89.5 ng/mL, urinary NGAL showed sensitivity of 84.6%, specificity of 59.6%, positive predictive value of 36.7%, and negative predictive value of 68.4%. 18 Kari et al also demonstrated that urinary NGAL levels were highly predictive of AKI (AUC=0.76, 95% CI 0.61-0.92). The cutoff point with the highest correctly classified proportion was 223 ng/mL, which correctly predict 80.0% patients with AKI, with a corresponding sensitivity of 72.7% and a specificity of 89.9%.…”

Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Acute Kidney Injury in Children With Shock: A Prospective Study

“…Some biomarkers with high sensitivity and specificity can be used as an efficient tool for the early detection of AKI, which will help prevent the burden of mortality and morbidity in intensive care units [14][15][16]. Neutrophil gelatinase-associated lipocalin (NGAL) has recently been identified as a strong marker in predicting early AKI [17,18]. Several published studies have stated that plasma NGAL level rises earlier than SrCr in AKI [19].…”