title: Serum neutrophil gelatinase-associated lipocalin (NGAL) in patients with Shiga toxin mediated haemolytic uraemic syndrome (STEC-HUS).
abstract: Neutrophil gelatinase-associated lipocalin (NGAL) is an increasingly used biomarker for acute kidney injury (AKI). Its utility in adult patients with AKI caused by Shiga toxin producing Escherichia coli infection (STEC)-associated haemolytic-uraemic syndrome (HUS), remains unknown. We aimed to evaluate the prognostic value of serum NGAL admission levels for the need of renal replacement therapy (RRT) in STEC-HUS patients. Baseline serum NGAL was determined by ELISA in 39 patients with STEC O104:H4 infection cared for at Hannover Medical School during the outbreak in Germany through May-July 2011. Patients with HUS had significant higher NGAL levels than healthy controls (379 [248 - 540] vs 39.0 [37.5-45] ng/ml, p < 0.0001). During clinical course, 24 patients required RRT at a median of five days after admission. NGAL admission levels were higher in patients requiring RRT (476 (344-639) ng/ml) compared to patients not requiring RRT (257 (196-426) ng/ml; p < 0.001). Unadjusted and adjusted logistic regression analyses identified NGAL as an independent predictor for need of RRT. In a combined model, a joint NGAL/AKIN classification approach improved the predictive accuracy for need of RRT over either marker alone. The combined categorical cut-off point defined by NGAL ≥ 330 ng/ml and presence of AKI (AKIN ≥ I) on admission correctly identified 20 of 24 patients requiring RRT (odds ratio 20, sensitivity 83%, specificity 80%, negative predictive value 75%, positive predictive value 87%). NGAL may serve as an adjunctive tool to improve risk prediction in patients with STEC-HUS.
authors.affiliation: Alexander Lukasz, MD, Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany, Tel.: +49 251 8347516, Fax: +49 251 8346979, E-mail: alexander-henrik.lukasz@ukmuenster.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lukasz
authors.forename: Jan
authors.initials: J
authors.lastname: Beneke
authors.forename: Jan
authors.initials: J
authors.lastname: Menne
authors.forename: Frank
authors.initials: F
authors.lastname: Vetter
authors.forename: Bernhard M W
authors.initials: BM
authors.lastname: Schmidt
authors.forename: Mario
authors.initials: M
authors.lastname: Schiffer
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Philipp
authors.initials: P
authors.lastname: Kümpers
authors.forename: Jan T
authors.initials: JT
authors.lastname: Kielstein
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000382:microbiology / Q000628:therapy; D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004927:Escherichia coli Infections / Q000097:blood* / Q000382:microbiology; D005260:Female; D005858:Germany; D006463:Hemolytic-Uremic Syndrome / Q000097:blood* / Q000382:microbiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D017582:Renal Replacement Therapy; D012307:Risk Factors; D054323:Shiga-Toxigenic Escherichia coli / Q000472:pathogenicity*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: Neutrophil gelatinase-associated lipocalin; Shiga toxin producing Escherichia coli; acute kidney injury; haemolytic-uraemic syndrome