title: Whole blood neutrophil gelatinase-associated lipocalin predicts acute kidney injury in burn patients.
abstract: BACKGROUND
  Early detection of acute kidney injury (AKI) in severely burn-injured patients can help alter treatment to prevent progression to acute failure and reduce the need for renal replacement therapy. We hypothesized that whole blood neutrophil gelatinase-associated lipocalin (NGAL) will be increased in severely burn-injured patients who develop AKI during acute resuscitation.
  
  
  METHODS
  We performed a prospective observation study of adult burn patients with a 20% total body surface area (TBSA) burned or greater burn injury. Two-hour serial measurements of NGAL, serum creatinine (Cr), and hourly urine output (UO) were collected for 48 h after admission. Our primary goal was to correlate the risk of AKI in the first week after burn injury with serial NGAL levels in the first 48 h after admission. Our secondary goal was to determine if NGAL was an earlier independent predictor of AKI compared with Cr and UO.
  
  
  RESULTS
  We enrolled 30 adult (age ≥ 18 y) burn patients with the mean ± standard deviation age of 40.9 ± 15.4 and mean TBSA of 46.4 ± 22.4. Fourteen patients developed AKI within the first 7 d after burn injury. There were no differences in age, TBSA, fluid administration, mean arterial pressure, UO, and Cr between AKI and no-AKI patients. NGAL was significantly increased as early as 4 h after injury (182.67 ± 83.3 versus 107.37 ± 46.15) in the AKI group. Controlling for age, TBSA, and inhalation injury, NGAL was a predictor of AKI at 4 h after injury (odds ratio, 1.02) and remained predictive of AKI for the period of more than the first 24 h after admission. UO and Cr were not predictive of AKI in the first 24 h after admission.
  
  
  CONCLUSIONS
  Whole blood NGAL is markedly increased in burn patients who develop AKI in the first week after injury. In addition, NGAL is an early independent predictor of AKI during acute resuscitation for severe burn injury. UO and Cr are not predictive of AKI during this time period.
authors.affiliation: Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California. Electronic address: soman.sen@gmail.com.
authors.forename: Soman
authors.initials: S
authors.lastname: Sen
authors.affiliation: Department of Pathology, University of California Davis, Sacramento, California.
authors.forename: Zack R
authors.initials: ZR
authors.lastname: Godwin
authors.affiliation: Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California.
authors.forename: Tina
authors.initials: T
authors.lastname: Palmieri
authors.affiliation: Division of Burn Surgery, Department of Surgery, University of California Davis, Sacramento, California.
authors.forename: David
authors.initials: D
authors.lastname: Greenhalgh
authors.affiliation: Department of Pathology, University of California Davis, Sacramento, California.
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Steele
authors.affiliation: Department of Pathology, University of California Davis, Sacramento, California.
authors.forename: Nam K
authors.initials: NK
authors.lastname: Tran
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology*; D000209:Acute-Phase Proteins; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002056:Burns / Q000097:blood / Q000150:complications*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D014556:Urine; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine
keywords: Acute renal injury; Burn injury; NGAL; Resuscitation