Urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients.
BACKGROUND
Neutrophil gelatinase-associated lipocalin (NGAL), an iron-transporting protein rapidly accumulating in the kidney tubules and urine after nephrotoxic and ischemic insults, has been put forward as an early, sensitive, non-invasive biomarker for acute kidney injury (AKI). The aim of this study was to evaluate urinary NGAL levels as a predictor of early AKI (first 5 days after injury) in multi-trauma patients.


METHODS
We studied multi-trauma adult patients admitted to the intensive care unit of a trauma hospital. Exclusion criteria were a) known cardiac or chronic kidney disease, and b) initial evaluation after more than 24 h had elapsed from injury. Urinary NGAL was measured using an ELISA technique upon admission and at 24 and 48 h. Presence of AKI was defined by the risk injury failure loss and end-stage kidney classification (RIFLE) criteria. Data are reported as median and interquartile range.


RESULTS
A total of 31 patients (25 male, 6 female) were studied. NGAL levels at admission were significantly higher among patients who subsequently developed AKI [155.5 (50.5-205.9) ng/mL vs. 8.0 (5.7-17.7) ng/mL, p=0.0000] and these higher levels persisted over the following 2 days. On the basis of receiver-operating characteristic analysis both NGAL and serum creatinine baseline measurements could predict AKI [area under the curve (95% confidence interval) 0.977 (0.823-0.980) and 0.789 (0.556-0.906), respectively], but the area under the curve for NGAL was significantly larger (p=0.024). A cut-off point >25 ng/mL for NGAL had a sensitivity of 0.91 and specificity of 0.95 in predicting AKI.


CONCLUSIONS
Urinary NGAL can be used from the 1st day of injury as a reliable predictor of early AKI in multi-trauma patients.
Makris
Konstantinos
K
Clinical Biochemistry Department, KAT General Hospital, Kiffissia, Athens, Greece. knmakris@hol.gr
Markou
Nikos
N
Evodia
Effimia
E
Dimopoulou
Eleni
E
Drakopoulos
Ioannis
I
Ntetsika
Konstantina
K
Rizos
Demetrios
D
Baltopoulos
George
G
Haliassos
Alexander
A
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D000209:Acute-Phase Proteins / Q000652:urine*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007668:Kidney / Q000293:injuries*; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D011237:Predictive Value of Tests; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine