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

Abstract

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.

Neutrophil Gelatinase-associated Lipocalin Predicts Post-traumatic Acute Kidney Injury in Severely Injured Patients

“…Several studies have shown that NGAL is a useful biomarker of AKI (32)(33)(34). NGAL was also found to be associated with the mortality of severely injured patients (35,36). In our study, all patients with AKI also developed MODS, but not all patients with MODS had AKI, indicating a correlation between AKI and NGAL, although this should not be regarded as absolute.…”

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

“…The prognostic value of NGAL in sepsis was presented in several studies and was not unambiguously verified [11][12][13][14]. Publications concerning the predictive value of NGAL in heterogeneous population of critically ill patients hospitalized in the mixed surgical-medical ICU are sparse [15][16][17][18].…”

Monitorization of NGAL, Creatinine and Renal Blood Flow in the Follow-up of Acute Kidney Injury in Intensive Care

“…The protein neutrophil gelatinase-associated lipocalin (NGAL) is made by neutrophils and other epithelial cells. It belongs to the lipocalin family of proteins, which transports small hydrophobic molecules including steroids, retinoids, and lipids (13)(14)(15) . Mishra et al first suggested it in 2003 as a marker of early kidney damage due to renal hypoperfusion (15,16) .…”

“…It belongs to the lipocalin family of proteins, which transports small hydrophobic molecules including steroids, retinoids, and lipids (13)(14)(15) . Mishra et al first suggested it in 2003 as a marker of early kidney damage due to renal hypoperfusion (15,16) . Renal tubular cells produce NGAL, a protein involved in natural immunity, in response to ischemic and toxic injury, and its concentration in serum and urine rises 8 to 24 hours before serum creatinine rises (9,17) .…”