Urinary Neutrophil Gelatinase-Associated Lipocalin in Cirrhotic Patients with Acute Kidney Injury

Hamdy, Hany; Ray, Ahmed El; Salaheldin, Mohamed; Lasheen, Mohammad; Aboul-Ezz, Mohamed A.; Abdelmoaty, Ahmed S.; Abdelrahim, A. B.

doi:10.5604/01.3001.0012.0931

Cited by 29 publications

(25 citation statements)

References 10 publications

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“…The 30-day and 1-year mortality rates in our study were 28.5% and 50%, similar to those reported in western cohorts 2,[27][28][29] . Previous studies have shown uNGAL levels' association with adverse in-hospital outcomes including mortality, which was likewise demonstrated in our study 18,[30][31][32][33][34][35] . However, there is a paucity of data contributing to the evidence base regarding associations between uNGAL and long-term renal outcomes after AKI.…”

Section: Discussionsupporting

confidence: 90%

Urine Neutrophil Gelatinase-associated Lipocalin (NGAL) for Prediction of Persistent AKI and Major Adverse Kidney Events

Lumlertgul

Amprai

Tachaboon

et al. 2020

Sci Rep

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We aimed to determine whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) can accurately predict persistent AKI, major adverse kidney events at 30 days (MAKE30) and 365 days (MAKE365) in hospitalized AKI patients. This is a retrospective study of adult patients who were admitted at King Chulalongkorn Memorial Hospital. We performed multivariable logistic regression for persistent AKI, MAKE30, and MAKE365. We developed equations for predicting MAKE30 and MAKE365 and divided the dataset into derivation and validation cohorts. uNGAL performance and predictive models were assessed using the area under the receiver operating characteristic curve (AROC). Among 1,322 patients with AKI, 76.9%, 45.1%, and 61.7% had persistent AKI, MAKE30, and MAKE365. The AROC were 0.75 (95% confidence interval[CI] 0.70-0.80), 0.66 (95%CI 0.61-0.71), and 0.64 (95%CI 0.59-0.70) for prediction of persistent AKI, MAKE30, and MAKE365 by uNGAL. The AROC in the validation dataset combining uNGAL with clinical covariates were 0.74 (95%CI 0.69-0.79) and 0.72 (95%CI 0.67-0.77) for MAKE30 and MAKE365. We demonstrated an association between uNGAL and persistent AKI, MAKE30, and MAKE365. Prediction models combining uNGAL can modestly predict MAKE30 and MAKE365. Therefore, uNGAL is a useful tool for improving AKI risk stratification. Acute kidney injury (AKI) is reported in 52.9-57.3% of critically ill patients and strongly associated with increased morbidity and mortality 1-3. In addition, AKI survivors have increased risk of developing chronic kidney disease (CKD), CKD progression, and end-stage kidney disease (ESRD). Factors associated with an increased risk of long-term complications include diabetes, older age, number of AKI episodes, AKI severity and serum albumin 4-6. Recently, AKI duration was ascertained as another prognostic factor for short-term and long-term mortality 7-10. Novel biomarkers measured at the time of intensive care unit (ICU) admission have been reported to predict short-term and long-term outcomes. Examples include urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary interleukin-18 (IL-18), urinary kidney injury molecule-1 (KIM-1), urinary insulin-like growth factor-binding protein-7 and tissue inhibitor of metalloproteinases-2 (TIMP-2xIGFBP-7) 11-13. uNGAL is a 25-kDa protein belonging to the lipocalin family. uNGAL is produced in renal epithelia and leukocytes in response to tubular injury and systemic inflammation. High uNGAL can be used to predict AKI 14-17 , discriminate intrinsic AKI from pre-renal AKI 18,19 , predict renal non-recovery, in-hospital mortality 20-22 , long-term

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Section: Discussionsupporting

confidence: 90%

Urine Neutrophil Gelatinase-associated Lipocalin (NGAL) for Prediction of Persistent AKI and Major Adverse Kidney Events

Lumlertgul

Amprai

Tachaboon

et al. 2020

Sci Rep

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“…Although considered standard tools in routine clinical tests, serum creatinine concentration and urine output are not suitable for the early detection of AKI, owing to inherent methodological problems. [2] Many potential biomarkers for the early detection of AKI have been identified, [3] including neutrophil gelatinase-associated lipocalin (NGA L), [4] N-acetyl-b-D-glucosaminidase (NAG), [5] interleukin 18 (IL-18), [6] glutathione S-transferase (GST), [7] kidney injury molecule-1 (KIM-1), [8] and liver-type fatty acid-binding protein (L-FABP). [9] More recently, urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) were reported to be superior to other biomarkers of AKI.…”

Section: Introductionmentioning

confidence: 99%

Comparison of urinary TIMP-2 and IGFBP7 cut-offs to predict acute kidney injury in critically ill patients

Zhang

Yuan²,

Guo³

et al. 2019

Medicine

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Background: Tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) are recently identified urinary biomarkers of acute kidney injury (AKI) in critically ill patients. Because their predictive accuracies vary widely, a meta-analysis was performed to evaluate the accuracy of previously reported urinary TIMP-2 and IGFBP7 cut-offs for predicting AKI. Methods: This meta-analysis was reported following the guideline of PRISMA. Four databases, PubMed, the Cochrane Library, the ISI Web of Knowledge, and Embase, were systematically searched from inception to June 2018 by 2 investigators, who independently selected studies, extracted relevant data, and evaluated study quality. A bivariate model was used to calculate the pooled estimates. Results: The search identified 5 studies with 1619 critically ill patients. Urinary TIMP-2 and IGFBP7 cut-off points of 0.3 (ng/ml) 2 /1000 had a sensitivity of 0.89 [95% confidence interval (CI) 0.85–0.93], a specificity of 0.48 (95% CI 0.45–0.51) and a diagnostic odds ratio (DOR) of 8.33 (95% CI 5.55–12.52). The area under the curve (AUC) estimated by the summary receiver operating characteristic (SROC) curve was 0.748. Based on 891 critically ill patients from 4 studies, urinary TIMP-2 and IGFBP7 cut-off points of 2.0 (ng/ml) 2 /1000 had a sensitivity of 0.45 (95% CI 0.37–0.53), a specificity of 0.93 (95% CI 0.91–0.95) and a DOR of 11.43 (95% CI 7.43–17.57). The AUC estimated by SROC was 0.844. Conclusion: Cut-off values around 0.3 (ng/ml) 2 /1000 (high sensitivity) and 2.0 (ng/ml) 2 /1000 (high specificity) could be accurate surrogate biomarkers predicting AKI in critically ill patients. The urinary TIMP-2 and IGFBP7 cut-off point of 2.0 (ng/mL) 2 /1000 appears to have the highest overall accuracy. Trial registration: PROSPERO registration number 2018: CRD42018084457 Registered on 11 February 2018.

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“…Moreover, the calculation of GFR is also limited in clinic due to oliguria or other disturbance factors. Recently, NGAL as a novel marker for renal injury has been suggested to be an excellent predictor of AKI in several pathological conditions like circulatory shock, cirrhosis, and sepsis . The novel role of NGAL in CNS diseases such as EAE, TBI, and cerebral aneurysms has been highlighted gradually .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, NGAL as a novel marker for renal injury has been suggested to be an excellent predictor of AKI in several pathological conditions like circulatory shock, cirrhosis, and sepsis. [21][22][23] The novel role of NGAL in CNS diseases such as EAE, TBI, and cerebral aneurysms has been highlighted gradually. 10,12,13 Here, we found the high level of serum NGAL occurred in the AIS patients with AKI and its level was correlated positively with the level of serum creatinine, suggesting that serum NGAL may reflect the change and severity of renal function in the early stage of AIS.…”

Section: Discussionmentioning

confidence: 99%

The clinical significance of neutrophil gelatinase‐associated lipocalin in ischemic stroke patients with acute kidney injury

Xiao

Chen

et al. 2019

Clinical Laboratory Analysis

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BackgroundAcute kidney injury (AKI) has become a common complication of acute ischemic stroke (AIS) and may have a significant impact on the clinical outcomes. Neutrophil gelatinase‐associated lipocalin (NGAL), an acute phase protein, has been identified as a novel biomarker for acute kidney impairment. Here, we studied the early expression of NGAL in AIS patients with AKI and its clinic value in predicting and diagnosis of AKI after stroke.MethodsA total of 205 subjects diagnosed as first‐ever AIS were recruited in this study, including 40 AIS with AKI and 165 AIS without AKI defined using the KDIGO guidelines. The serum and urine levels of NGAL were measured with ELISA. To evaluate the clinic value of NGAL, we also detected creatinine, urea nitrogen and cystatin C and microalbumin (mALB) in serum or urine using chemiluminescence or immunoturbidimetry method, and then the receiver operating characteristic (ROC) curve and correlation was analyzed. The severity of AIS patients was evaluated based on the National Institutes of Health Stroke Scale (NIHSS) score.ResultsThe serum and urine NGAL levels were significantly increased in AIS patients with AKI, and line regression analysis indicated that there was a positive correlation between the serum NGAL and creatinine level in AIS patients accompanied AKI. Additionally, the concentration of serum NGAL in AIS patients with AKI increased with the severity of stroke.ConclusionThe increased serum NGAL may be used as a valuable complementary marker for the diagnoses and prediction of AKI in the early stage of AIS patients.

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Urinary Neutrophil Gelatinase-Associated Lipocalin in Cirrhotic Patients with Acute Kidney Injury

Abstract: A single baseline measurement of uNGAL level has the ability to determine type of kidney dysfunction in cirrhotic patients, perhaps accelerating management decisions and improving outcomes.

Cited by 29 publications

References 10 publications

Urine Neutrophil Gelatinase-associated Lipocalin (NGAL) for Prediction of Persistent AKI and Major Adverse Kidney Events

Urine Neutrophil Gelatinase-associated Lipocalin (NGAL) for Prediction of Persistent AKI and Major Adverse Kidney Events

Comparison of urinary TIMP-2 and IGFBP7 cut-offs to predict acute kidney injury in critically ill patients

The clinical significance of neutrophil gelatinase‐associated lipocalin in ischemic stroke patients with acute kidney injury

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