title: Plasma neutrophil gelatinase-associated lipocalin as a predictive biomarker for the detection of acute kidney injury in adult poisoning.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a serious complication in intoxicated patients. Recently, a new biomarker - neutrophil gelatinase-associated lipocalin (NGAL) - was used to predict AKI in patients who were critically ill or had sepsis.
  
  
  OBJECTIVE
  To evaluate the utility of plasma NGAL as an early predictor of AKI in adults with acute poisoning.
  
  
  METHODS
  This retrospective, observational, cohort study was conducted between December 2013 and November 2014. A total of 157 consecutive adult patients who presented to the emergency department (Level 1 regional center) of Kyungpook National University Hospital, a tertiary teaching hospital in Daegu, Korea, within 24 h of poisoning were included. Initial plasma NGAL levels and laboratory parameters were concurrently measured upon hospital arrival. AKI was defined according to Acute Kidney Injury Network criteria. Development of AKI was predicted using plasma NGAL levels and by analyzing the area under the receiver operating characteristic curve (AUC).
  
  
  RESULTS
  The overall rate of AKI was 14.6% (n = 23). Plasma NGAL levels in the AKI group were higher than those in the non-AKI group (median, 310 vs. 86 ng/mL; p < 0.001). Additionally, baseline NGAL levels allowed for better prediction of AKI than initial creatinine levels. The AUC of plasma NGAL was 0.895 (95% confidence interval [CI]: 0.832-0.941), with a cut-off value of 227 ng/mL (sensitivity, 76.2%; specificity, 95.8%). Plasma NGAL had a higher predictive capacity for AKI than serum creatinine (AUC 0.741, 95% CI: 0.662-0.810), base deficit (AUC 0.795, 95% CI: 0.701-0.870), lactate (AUC 0.781, 95% CI: 0.690-0.856), and anion gap (AUC 0.636, 95% CI: 0.535-0.730).
  
  
  CONCLUSIONS
  Plasma NGAL may serve as a good predictor of AKI in cases of adult poisoning.
authors.affiliation: a Department of Emergency Medicine , School of Medicine, Kyungpook National University , Daegu , Republic of Korea ;
authors.forename: Jae Yun
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: a Department of Emergency Medicine , School of Medicine, Kyungpook National University , Daegu , Republic of Korea ;
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: b Department of Emergency Medicine , Dongguk University Ilsan Hospital, College of Medicine, Dongguk University , Seoul , Republic of Korea ;
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Seo
authors.affiliation: c Division of Critical Care and Disaster Medicine, Department of Emergency Medicine , Dongguk University College of Medicine, Dongguk University Gyeongju Hospital , Gyeongju , Republic of Korea.
authors.forename: Daihai
authors.initials: D
authors.lastname: Choi
authors.affiliation: a Department of Emergency Medicine , School of Medicine, Kyungpook National University , Daegu , Republic of Korea ;
authors.forename: Jeong Bae
authors.initials: JB
authors.lastname: Park
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis*; D000209:Acute-Phase Proteins; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012372:ROC Curve; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D019344:Lactic Acid; D003404:Creatinine
keywords: Acute kidney injury; diagnosis; neutrophil gelatinase-associated lipocalin; poisoning