Urinary Neutrophil Gelatinase-Associated Lipocalin Measured on Admission to the Intensive Care Unit Accurately Discriminates between Sustained and Transient Acute Kidney Injury in Adult Critically Ill Patients

Abstract

Background: First we aimed to evaluate the ability of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin-C (CyC) in plasma and urine to discriminate between sustained, transient and absent acute kidney injury (AKI), and second to evaluate their predictive performance for sustained AKI in adult intensive care unit (ICU) patients. Methods: A prospective cohort study of 700 patients was studied. Sample collection was performed over 8 time points starting on admission. Results: After exclusion 510 patients remained for the analysis. All biomarkers showed significant differentiation between sustained and no AKI at all time points (p ≤ 0.0002) except for urine CyC (uCyC) on admission (p = 0.06). Urine NGAL (uNGAL) was the only biomarker significantly differentiating sustained from transient AKI on ICU admission (p = 0.02). Individually, uNGAL performed better than the other biomarkers (area under the curves, AUC = 0.80, 95% confidence interval, CI = 0.72–0.88) for the prediction of sustained AKI. The combination with plasma NGAL (pNGAL) showed a nonsignificant improvement (AUC = 0.83, 95% CI = 0.75–0.91). The combination of individual markers with a model of clinical characteristics (MDRD eGFR, HCO₃^– and sepsis) did not improve its performance significantly. However, the integrated discrimination improvement showed significant improvement when uNGAL was added (p = 0.04). Conclusions: uNGAL measured on ICU admission differentiates patients with sustained AKI from transient or no-AKI patients. Combining biomarkers such as pNGAL, uNGAL and plasma CyC with clinical characteristics adds some value to the predictive model.

Urine neutrophil gelatinase-associated lipocalin in septic patients with and without acute kidney injury

“…21 Similarly, a recent study in a cohort of 45 sepsis patients showed the parameter uNGAL was a good diagnostic marker for AKI development, but not for AKI severity, when it was recorded after a rise in SCr had occurred. [22][23][24] In our study, the peak uNGAL was found to be correlated with the laboratory and clinical parameters, reflecting the severity of septic AKI (Figure 1). The diagnostic accuracy for septic AKI was highest with the peak uNGAL, as compared with the admission uNGAL (Figure 2).…”

Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically Ill Patients: A Post-Hoc Analysis

“…We performed a post-hoc analysis on a prospectively gathered biomarker dataset from a previously published cohort [12,13]. The institutional review board of Erasmus MC, University Medical Center Rotterdam, The Netherlands, approved the initial study.…”

Diagnostic accuracy of urinary neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury

“…25,26 In our study, ten patients (11.4%) did not progress beyond the AKIN stage II, indicating that some patients in this group probably had functional renal failure (transient AKI or prerenal azotemia) without any significant renal tubular injury. The incidence of transient AKI was similar to the study done by Hoste et al 27 (18%).…”