Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population.
OBJECTIVE
Neutrophil gelatinase-associated lipocalin (NGAL) is a useful marker for acute kidney injury (AKI), particularly when the timing of renal insult is known. However, its performance in an adult critical care setting has not been well described. We performed this study to estimate the diagnostic accuracy of plasma NGAL for early detection of AKI and need for renal replacement therapy (RRT) in an adult intensive care unit (ICU).


METHODS
We enrolled 307 consecutive adult patients admitted to a general medical-surgical ICU; 301 were included in the final analysis. Serial blood samples were analyzed for plasma NGAL using a standardized clinical platform. The primary outcome was AKI, defined as an increase in creatinine of at least 50% from baseline or a reduction in urine output to <0.5 ml/kg/h for >6 h.


RESULTS
Of 301 patients, 133 (44%) had AKI during their ICU stay. Plasma NGAL was a good diagnostic marker for AKI development within the next 48 h (area under ROC 0.78, 95% CI 0.65-0.90), and for RRT use (area under ROC 0.82, 95% CI 0.70-0.95). Peak plasma NGAL concentrations increased with worsening AKI severity (R = 0.554, P < 0.001).


CONCLUSIONS
Plasma NGAL is a useful early marker for AKI in a heterogeneous adult ICU population, in which the timing of renal insult is largely unknown. It allows the diagnosis of AKI up to 48 h prior to a clinical diagnosis based on AKI consensus definitions. Additionally, it predicts need for RRT and correlates with AKI severity. Early identification of high risk patients may allow potentially beneficial therapies to be initiated early in the disease process before irreversible injury occurs.
Cruz
Dinna N
DN
Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy. dinnacruzmd@yahoo.com
de Cal
Massimo
M
Garzotto
Francesco
F
Perazella
Mark A
MA
Lentini
Paolo
P
Corradi
Valentina
V
Piccinni
Pasquale
P
Ronco
Claudio
C
D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D017582:Renal Replacement Therapy; D012680:Sensitivity and Specificity
D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins