title: Predictive value of plasma neutrophil gelatinase-associated lipocalin for acute kidney injury in intensive care unit patients after major non-cardiac surgery.
abstract: OBJECTIVE
  The performance of plasma neutrophil gelatinase-associated lipocalin (pNGAL) for prediction of acute kidney injury (AKI) in non-cardiac surgical patients has not been well described. This study investigates the use of pNGAL for early detection of AKI in patients admitted to an intensive care unit (ICU) after major or ultra-major non-cardiac surgery.
  
  
  METHODS
  A total of 151 patients were recruited. Blood samples at 0 h and 6 h post-ICU admission were collected. Primary outcome was occurrence of AKI within 48 h of ICU admission defined using Acute Kidney Injury Network (AKIN) classification.
  
  
  RESULTS
  Forty-five (29.8%) patients developed AKI within 48 h of ICU admission. Among them, 22, 14, and nine were classified as AKIN Stage 1, 2, and 3 respectively. pNGAL levels at 0 h and 6 h were significantly related to AKI severity. The AUROC for pNGAL at 0 h and 6 h increased with AKI severity (AKIN stage ≥1 0.671 ± 0.048 and 0.691 ± 0.047; stage ≥2 0.737 ± 0.055 and 0.796 ± 0.048; stage 3 0.829 ± 0.072 and 0.860 ± 0.065, respectively) and requirement of renal replacement therapy (0.880 ± 0.059 & 0.837 ± 0.088). Change of pNGAL from 0 h to 6 h showed no advantage in predictive power compared with pNGAL level at 0 h or 6 h alone. The addition of pNGAL into clinical AKI prediction model could only provide marginal benefit.
  
  
  CONCLUSIONS
  pNGAL correlated with severity of AKI and requirement of renal replacement therapy in ICU patients who received major or ultra-major non-cardiac surgery. However, the benefit of adding pNGAL into clinical AKI prediction model is marginal.
authors.affiliation: Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China.
authors.forename: Hoi-Ping
authors.initials: HP
authors.lastname: Shum
authors.forename: Natalie Yuk-Wah
authors.initials: NY
authors.lastname: Leung
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Chang
authors.forename: Oi-Yan
authors.initials: OY
authors.lastname: Tam
authors.forename: Arthur Ming-Chit
authors.initials: AM
authors.lastname: Kwan
authors.forename: King-Chung
authors.initials: KC
authors.lastname: Chan
authors.forename: Wing-Wa
authors.initials: WW
authors.lastname: Yan
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve; D017582:Renal Replacement Therapy; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000209:Acute-Phase Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: acute kidney injury; biomarker; neutrophil gelatinase-associated lipocalin; postoperative complications