Urinary Neutrophil Gelatinase–Associated Lipocalin as an Early Predictor of Disease Severity and Mortality in Acute Pancreatitis

Lipiński, Michał; Rydzewska–Rosołowska, Alicja; Rydzewski, Andrzej; Rydzewska, Grażyna

doi:10.1097/mpa.0000000000000282

Cited by 22 publications

(20 citation statements)

References 32 publications

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“…In another study, urinary NGAL levels were found to be significantly elevated in patients with severe AP and in patients who died. Elevated NGAL levels at admission and after 24 h could predict severe AP and mortality . In our study, we also found that urinary and serum NGAL levels could differentiate mild, moderate, and severe AP.…”

Section: Discussionsupporting

confidence: 75%

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Neutrophil gelatinase‐associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis

et al. 2018

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Background and Aim Acute kidney injury (AKI) in severe acute pancreatitis (SAP) has a high mortality rate. Traditionally used serum creatinine is an insensitive biomarker for the early detection of AKI. We aimed to study the role of plasma and urinary neutrophil gelatinase‐associated lipocalin (NGAL) in predicting AKI and a severe course in patients with acute pancreatitis (AP). Methods Consecutive patients of AP who presented within 72 h of symptom onset and age‐ and gender‐matched healthy controls were included. Urinary and serum NGAL levels [enzyme‐linked immunosorbent assay (ELISA)] were evaluated within 24 h of and 72 h after admission and once in controls. Urine and serum NGAL levels were correlated with development of AKI, severity, and outcomes of AP. Results Fifty patients with AP and 30 controls were enrolled. The mean serum and urine NGAL levels in patients on day 1 were significantly higher than the serum and urine NGAL levels in controls (P < 0.001). After excluding patients with AKI on day 1 (n = 10), both serum and urinary NGAL levels on days 1 and 3 were significantly higher in patients who subsequently developed AKI (n = 11) compared to those who did not (n = 29) (P = 0.02, 0.01 and P < 0.001, 0.03). A urinary NGAL level of 221.03 ng/mL on day 1 predicted AKI with a sensitivity and specificity of 82 and 80%, respectively (AUC = 0.9). Mean serum and urinary NGAL levels on day 1 were significantly elevated in patients with SAP compared to those without SAP (P = 0.04 and <0.001). Conclusion NGAL levels in urine and serum can predict severity of AP and development of AKI.

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Section: Discussionsupporting

confidence: 75%

“…There are limited data showing serum and urinary NGAL as a marker of severe AP and as a predictor of AKI in AP . The aim of this prospective study was to compare urinary and serum NGAL levels in predicting the development of AKI, severity, and mortality in patients with AP.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil gelatinase‐associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis

et al. 2018

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“…Early recognition of disease severity and appropriate therapeutic interventions are extremely crucial for reducing the rates of morbidity and mortality in AP. Patients with a 24-hour delay in admission presented with a 4-fold increase in the risk of death; Prediction of AP severity, especially during the early stage, is still difficult and constitutes a challenge for clinicians 18 , 19 . Therefore, the current study was designed to delineate potential predictors to forecast early occurrence of SAP during the clinical course.…”

Section: Discussionmentioning

confidence: 99%

The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis

Han

Zeng

Lin

et al. 2017

Sci Rep

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It is important to identify the patients with high-risk progression to develop severe acute pancreatitis (SAP). The study was to assess whether neutrophil to lymphocyte ratio (NLR) and fluid sequestration (FS) could represent useful markers for predicting the severity. A total of 1639 patients who underwent clinical diagnosis of AP was performed. Various serologic and clinical parameters on admission were investigated. Chronologic change in NLR and FS were analyzed, and theirs utility for predicting severity of AP was evaluated by receiver operator characteristic (ROC) curve analysis. Correlation analysis was assessed by Spearman’s rank test. NLR and FS levels were both increased significantly in SAP and positively correlated with Ranson score and hospital stays. The ROC curve analyses showed the optimal cut-off values of NLR for admission with day0, day1, day2 were 9.64, 6.66 and 6.50, giving sensitivity of 77–82%. The optimal cut-off values of FS for admission with day1, day2, day3 were 1375 ml, 2345 ml and 3424 ml, giving sensitivity of 62–75%. Moreover, measurement of NLR and FS together exhibited a similar area under curve (AUC) and sensitivity for SAP prediction compared with the those of Ranson score. Increase of NLR and FS are correlated with severity and can be suggested as a predictive factor in an early stage of AP.

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“…More recently, Hong et al 41 calculated an AUC of 0.80 in 470 patients with sepsis followed for up to 28 days. Meanwhile, Lipinski et al 42 discovered that admission and day one urine levels of NGAL were highly predictive of mortality from pancreatitis, with AUC values of 0.98 and 0.92. However, Yang et al 43 found that, though both urine and plasma levels of NGAL obtained during the first 12 hours post admission predicted early AKI and mortality in patients with massive burns, they did not predict long-term mortality.…”

Section: Discussionmentioning

confidence: 99%

Urinary neutrophil gelatinase-associated lipocalin is an excellent predictor of mortality in intensive care unit patients

Algethamy

Albeladi

2017

SMJ

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Objectives:To assess urine neutrophil gelatinase-associated lipocalin (uNGAL) level as a potential predictor of acute kidney injury (AKI), and both intensive care unit (ICU) and in-hospital mortality.Methods:Patients presenting to our ICU with a systolic blood pressure (SBP) <90 mmHg or mean arterial pressure (MAP) <65 mmHg, and no prior kidney disease were followed prospectively. Baseline data were collected on patient demographics, admission diagnosis, APACHE II and SOFA scores, SBP, MAP, serum creatinine and cystatin C, and uNGAL. Patients were monitored throughout hospitalization, including daily uNGAL, serum creatinine and cystatin C, and continuous MAP. Bivariate analysis compared those dying in the ICU and in-hospital versus survivors; with hierarchical binary logistic regression used to identify predictors of mortality. Areas under receiver-operating-characteristic curves (AUC) were used to measure sensitivity and specificity at different uNGAL thresholds.Results:Among 75 patients followed, 16 died in the ICU, and another 24 prior to hospital discharge. Mortality rates were greatest in trauma and sepsis patients. The ICU survivors differed from non-survivors in almost all clinical variables; but only 2 predicted ICU mortality on multivariate analysis: day one uNGAL (p=0.01) and 24-hour APACHE II score (p=0.07). Only the APACHE II score significantly predicted in-hospital mortality (p=0.003). The AUC for day one uNGAL was greater for ICU (AUC=0.85) than in-hospital mortality (AUC=0.74).Conclusions:Day one uNGAL is a highly accurate predictor of ICU, but less so for in-hospital mortality.

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Urinary Neutrophil Gelatinase–Associated Lipocalin as an Early Predictor of Disease Severity and Mortality in Acute Pancreatitis

Abstract: The urinary level of NGAL is a promising new diagnostic and prognostic factor for severe AP in an early stage of the disease.

Cited by 22 publications

References 32 publications

Neutrophil gelatinase‐associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis

Neutrophil gelatinase‐associated lipocalin: An early biomarker for predicting acute kidney injury and severity in patients with acute pancreatitis

The utility of neutrophil to lymphocyte ratio and fluid sequestration as an early predictor of severe acute pancreatitis

Urinary neutrophil gelatinase-associated lipocalin is an excellent predictor of mortality in intensive care unit patients

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