Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness.
OBJECTIVE
Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI). We evaluated the diagnostic and prognostic accuracies of plasma NGAL (pNGAL) for contrast-induced AKI (CI-AKI) in critically ill patients.


METHODS
In a prospective observational study in two adult intensive care units in a university hospital, 100 consecutive critically ill patients with stable serum creatinine concentrations up to 48 h before contrast medium (CM) injection were enrolled. Serial blood sampling for pNGAL analysis was performed at enrolment, 2, 6, and 24 h after CM injection. The primary outcome was CI-AKI, defined by AKIN criteria, within the first 72 h following CM injection. Secondary outcomes were the need for renal replacement therapy (RRT) and mortality.


RESULTS
Of the 98 patients analyzed, 30 developed CI-AKI. The pNGAL levels did not differ in patients with or without CI-AKI, and were higher in septic patients compared to nonseptic patients, and in patients with AKI preceding CM injection. The discriminative value of pNGAL to predict CI-AKI and mortality was poor; although, it did predict the need for RRT requirement after CM injection (area under receiver-operating characteristic curve, 0.85, 0.80, 0.83 and 0.86 at H0, H2, H6 and H24, respectively).


CONCLUSIONS
CI-AKI was common in critically ill patients. pNGAL levels were higher in patients with sepsis or previous AKI, but did not help to diagnose CI-AKI any earlier than serum creatinine after CM injection. However, pNGAL could be of interest to detect patients at risk of subsequent RRT requirement.
Service de Réanimation Médicale, CHU de Caen, Caen, France.
Xavier
X
Valette
Benoit
B
Savary
Marie
M
Nowoczyn
Cédric
C
Daubin
Véronique
V
Pottier
Nicolas
N
Terzi
Amélie
A
Seguin
Sabine
S
Fradin
Pierre
P
Charbonneau
Jean-Luc
JL
Hanouz
Damien
D
du Cheyron
D058186:Acute Kidney Injury / Q000097:blood* / Q000139:chemically induced* / Q000401:mortality; D000368:Aged; D000792:Angiography; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003287:Contrast Media / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005260:Female; D018093:Gelatinases / Q000097:blood*; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units; D054834:Lipocalins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D011446:Prospective Studies; D012372:ROC Curve; D017582:Renal Replacement Therapy; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000401:mortality; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D003287:Contrast Media; D054834:Lipocalins; D003404:Creatinine; D018093:Gelatinases