title: Urine neutrophil gelatinase associated lipocalin as an early marker of acute kidney injury in hematopoietic stem cell transplantation patients.
abstract: Acute kidney injury (AKI) is common in hematopoietic stem cell transplantation (HSCT) patients with an incidence of 21-73%. Prevention and early diagnosis reduces the frequency and severity of this complication. Predictive biomarkers are of major importance to timely diagnosis. Neutrophil gelatinase associated lipocalin (NGAL) is a widely investigated novel biomarker for early diagnosis of AKI. However, no study assessed NGAL for AKI diagnosis in HSCT patients. We performed further analyses on gathered data from our recent trial to evaluate the performance of urine NGAL (uNGAL) as an indicator of AKI in 72 allogeneic HSCT patients. AKI diagnosis and severity were assessed using Risk-Injury-Failure-Loss-End-stage renal disease and AKI Network criteria. We assessed uNGAL on days -6, -3, +3, +9 and +15. Time-dependent Cox regression analysis revealed a statistically significant relationship between uNGAL and AKI occurrence. (HR = 1.04 (1.008-1.07), p = 0.01). There was a relation between uNGAL day + 9 to baseline ratio and incidence of AKI (unadjusted HR = 1.047 (1.012-1.083), p < 0.01). The area under the receiver-operating characteristic curve for day + 9 to baseline ratio was 0.86 (0.74-0.99, p < 0.01) and a cut-off value of 2.62 was 85% sensitive and 83% specific in predicting AKI. Our results indicated that increase in uNGAL augmented the risk of AKI and the changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients. Additionally uNGAL changes preceded serum Cr raises by nearly 2 days.
authors.affiliation: a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran .
authors.forename: Maryam
authors.initials: M
authors.lastname: Taghizadeh-Ghehi
authors.affiliation: a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran .
authors.forename: Amir
authors.initials: A
authors.lastname: Sarayani
authors.affiliation: a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran .|b Department of Epidemiology and Biostatistics , School of Public Health, Tehran University of Medical Sciences , Tehran , Iran , and.
authors.forename: Asieh
authors.initials: A
authors.lastname: Ashouri
authors.affiliation: c Clinical Pharmacy Department , Faculty of Pharmacy, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Sara
authors.initials: S
authors.lastname: Ataei
authors.affiliation: c Clinical Pharmacy Department , Faculty of Pharmacy, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Moslehi
authors.affiliation: a Research Center for Rational Use of Drugs, Tehran University of Medical Sciences , Tehran , Iran .|c Clinical Pharmacy Department , Faculty of Pharmacy, Tehran University of Medical Sciences , Tehran , Iran.
authors.forename: Molouk
authors.initials: M
authors.lastname: Hadjibabaie
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000328:Adult; D015415:Biomarkers / Q000652:urine; D004311:Double-Blind Method; D042241:Early Diagnosis; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins
keywords: Acute kidney injury; hemtopoietic stem cell transplantation; nephrotoxicity; neutrophil gelatinase associated lipocalin; receiver-operating characteristic curve