title: Whole-blood neutrophil gelatinase-associated lipocalin to predict adverse events in acute kidney injury: A prospective observational cohort study.
abstract: OBJECTIVE
  Acute kidney injury is common in intensive care units and is associated with increased morbidity and mortality. We evaluated the ability of whole-blood neutrophil gelatinase-associated lipocalin (wbNGAL) to predict mortality and need for renal replacement therapy (RRT) in critically ill patients with kidney dysfunction.
  
  
  METHODS
  We prospectively enrolled adult patients in 5 Canadian intensive care units. We measured wbNGAL at the time of enrollment to determine whether NGAL concentration could predict the primary composite outcome of death or need for RRT by day 30 in addition to other secondary outcomes.
  
  
  RESULTS
  We recruited 234 patients; 227 were included in the analysis. In a multivariable model, wbNGAL did not predict 30-day mortality or need for RRT (odds ratio, 1.05; 95% confidence interval, 0.99-1.12). Neutrophil gelatinase-associated lipocalin was similar in patients who died (654 [303-1180] ng/mL) vs those who survived (541.5 [255.5-1080] ng/mL, P=.26) by 90 days. Whole-blood NGAL poorly predicted the primary outcome (area under receiver operator curve, 0.65; 95% confidence interval, 0.58-0.73).
  
  
  CONCLUSIONS
  In a cohort of critically ill patients with abnormal kidney function, wbNGAL was not effective in the prediction of death or RRT within 30 days. These data do not support the use of this biomarker for the detection of clinical outcomes in this population.
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Ave, Room D1.08, Toronto, ON, Canada M4N 3M5. Electronic address: oleksa.rewa@utoronto.ca.
authors.forename: Oleksa
authors.initials: O
authors.lastname: Rewa
authors.affiliation: Division of Nephrology, St. Michael's Hospital and University of Toronto, 30 Bond St, Toronto, ON, Canada M5B 1W8; Keenan Research Institute, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8. Electronic address: waldR@smh.ca.
authors.forename: Ron
authors.initials: R
authors.lastname: Wald
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Ave, Room D1.08, Toronto, ON, Canada M4N 3M5; Department of Critical Care Medicine, 2075 Bayview Ave, Room D1.08, Toronto, ON, Canada M4N 3M5. Electronic address: neill.adhikari@sunnybrook.ca.
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Ave, Room D1.08, Toronto, ON, Canada M4N 3M5; Division of Nephrology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Suite A206a, Toronto, ON, Canada M4N 3M5. Electronic address: Michelle.Hladunewich@sunnybrook.ca.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hladunewich
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Ave, Room D1.08, Toronto, ON, Canada M4N 3M5; Mount Sinai Hospital, 600 University Ave Suite 18 214, Toronto, ON, Canada M5G 1X5. Electronic address: slapinsky@mtsinai.on.ca.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lapinsky
authors.affiliation: Queen's University, 99 University Ave, Kingston, ON, Canada K7L 3N6; Kingston General Hospital, 76 Stuart St, Room 5-411, Angada 4, Kingston, ON, Canada K7L 2V7. Electronic address: muscedej@KGH.KARI.NET.
authors.forename: John
authors.initials: J
authors.lastname: Muscedere
authors.affiliation: University of Alberta, 116 St and 85a Ave, Edmonton, AB, Canada T6G 2R3; Division of Critical Care Medicine, University of Alberta, 8440 112 St NW, Critical Care Medicine 2-124E Clinical Sciences Bldg, Edmonton, AB, Canada T6G 2B7. Electronic address: bagshaw@ualberta.ca.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Keenan Research Institute, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8. Electronic address: Smitho@smh.ca.
authors.forename: Orla M
authors.initials: OM
authors.lastname: Smith
authors.affiliation: Keenan Research Institute, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; Applied Health Research Centre, Li Ka Shing Knowledge Institute, 193 Yong St, Toronto, ON, Canada M5B 1M8. Electronic address: LebovicG@smh.ca.
authors.forename: Gerald
authors.initials: G
authors.lastname: Lebovic
authors.affiliation: Department of Medicine, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel. Electronic address: rottemk@yahoo.com.
authors.forename: Rottem
authors.initials: R
authors.lastname: Kuint
authors.affiliation: Interdepartmental Division of Critical Care Medicine, University of Toronto, 2075 Bayview Ave, Room D1.08, Toronto, ON, Canada M4N 3M5; Keenan Research Institute, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, ON, Canada M5B 1W8; Applied Health Research Centre, Li Ka Shing Knowledge Institute, 193 Yong St, Toronto, ON, Canada M5B 1M8. Electronic address: KleinD@smh.ca.
authors.forename: David J
authors.initials: DJ
authors.lastname: Klein
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality / Q000628:therapy; D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data
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; Critical care; Mortality; Neutrophil gelatinase-associated lipocalin; Renal replacement therapy