Sepsis and AKI in Clinical Emergency Room Patients: The Role of Urinary NGAL.
BACKGROUND
Few studies have investigated the predictive properties of urinary (u) NGAL as an AKI marker in septic population.


OBJECTIVE
This study evaluated the efficacy of uNGAL as predictor of AKI and death in septic patients admitted to the clinical emergency room (ER).


METHODS
We prospectively studied patients with sepsis admitted to the ER. Urine was analyzed for NGAL within the first 24 hours after admission (classified as NGAL1), between 24 and 48 h (NGAL2), and at moment of AKI diagnosis (NGAL3).


RESULTS
Among 168 septic patients admitted to ER, 72% developed AKI. The uNGAL and its relationship with creatinine (Cr) were high in septic patients but statistically higher in those with sepsis and AKI. The uNGAL1 and uNGAL2, as well as uNGAL1/uCr1 and uNGAL2/uCr2, were good predictors for AKI (AUC-ROC 0.73, 0.70, 0.77, and 0.84, resp.). The uNGAL1 and uNGAL1/uCr1 were poor predictors for death (AUC-ROC 0.66 and 0.68, resp.), whereas uNGAL2 and uNGAL2/uCr2 were better predictors (AUC-ROC 0.70 and 0.81, resp.).


CONCLUSIONS
The uNGAL is highly sensitive but nonspecific predictor of AKI and death in septic patients admitted into ER.
São Paulo State University (UNESP), Distrito de Rubião Junior, s/n, 18618-970 Botucatu, SP, Brazil.
Hong Si
HS
Nga
São Paulo State University (UNESP), Distrito de Rubião Junior, s/n, 18618-970 Botucatu, SP, Brazil.
Pamela
P
Medeiros
São Paulo State University (UNESP), Distrito de Rubião Junior, s/n, 18618-970 Botucatu, SP, Brazil.
Precil
P
Menezes
São Paulo State University (UNESP), Distrito de Rubião Junior, s/n, 18618-970 Botucatu, SP, Brazil.
Ramaiane
R
Bridi
São Paulo State University (UNESP), Distrito de Rubião Junior, s/n, 18618-970 Botucatu, SP, Brazil.
André
A
Balbi
São Paulo State University (UNESP), Distrito de Rubião Junior, s/n, 18618-970 Botucatu, SP, Brazil.
Daniela
D
Ponce
D058186:Acute Kidney Injury / Q000150:complications* / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine*; D000368:Aged; D003710:Demography; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D011518:Proto-Oncogene Proteins / Q000652:urine*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000150:complications* / Q000652:urine*; D016896:Treatment Outcome
D000209:Acute-Phase Proteins; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins