title: Plasma neutrophil gelatinase-associated lipocalin as an early predicting biomarker of acute kidney injury and clinical outcomes after recovery of spontaneous circulation in out-of-hospital cardiac arrest patients.
abstract: OBJECTIVE
  To determine whether the level of plasma neutrophil gelatinase-associated lipocalin (NGAL) can predict acute kidney injury (AKI) and clinical outcomes after recovery of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA).
  
  
  METHODS
  We conducted a prospective observational study of consecutive admitted patients with ROSC after OHCA between January 2013 and March 2015. Plasma was collected within 4h of ROSC to determine the level of NGAL. Outcome variables were AKI, 30-day survival, and good neurological outcome (GNO). We evaluated the association between NGAL and outcomes.
  
  
  RESULTS
  Fifty-four patients were included. AKI occurred in 26 (48.0%); 15 (27.7%) survived over 30 days and 8 had GNO (14.8%). NGAL was significantly lower in the group with non-AKI, 30-day survival, and GNO. To predict AKI, 30-day survival, and GNO, the area under the receiver operating characteristic curve for NGAL was 0.810, 0.728, and 0.875, respectively. In a logistic regression model, NGAL >189 ngml(-1) was strongly associated with AKI (odds ratio [OR] 7.01, 95% confidence interval [CI]: 1.89-26.01) in a multivariate model. A lower level of NGAL was strongly associated with 30-day survival (OR 6.12, 95% CI: 1.64-23.42 at NGAL <153.5 ngml(-1)) and GNO (OR 19.83, 95% CI: 2.21-178.32 at NGAL <129.5 ngml(-1)) in a univariate model, but was not significantly associated with outcomes in a multivariate model.
  
  
  CONCLUSIONS
  Plasma NGAL is a strong predictor of AKI in patients exhibiting OHCA at ICU admission. Lower levels of NGAL are associated with greater chance of 30-day survival and GNO.
authors.affiliation: Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea. Electronic address: empso@kuh.ac.kr.
authors.forename: Sang O
authors.initials: SO
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: jyahn@hallym.or.kr.
authors.forename: Ji Yun
authors.initials: JY
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea; Department of emergency medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, Republic of Korea. Electronic address: hwaniyo@naver.com.
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: dbwjddl1011@hanmail.net.
authors.forename: Yu Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: xgaryx@naver.com.
authors.forename: Yong Hun
authors.initials: YH
authors.lastname: Min
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: gsemdr68@hallym.or.kr.
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: medysohn@hallym.or.kr.
authors.forename: You Dong
authors.initials: YD
authors.lastname: Sohn
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: aukawa1@naver.com.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Republic of Korea. Electronic address: powerfreeze@hanmail.net.
authors.forename: Young Taeck
authors.initials: YT
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School Medicine, Seoul, Republic of Korea. Electronic address: sinndhk@medimail.co.kr.
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Shin
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000209:etiology*; D015415:Biomarkers / Q000097:blood; D001775:Blood Circulation; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D000071068:Lipocalin-2 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000097:blood* / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function
chemical_list: D015415:Biomarkers; D000071068:Lipocalin-2
keywords: Acute kidney injury; NGAL; Out-of-hospital cardiac arrest; Survival; Treatment outcome