title: Plasma Neutrophil Gelatinase-Associated Lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis.
abstract: OBJECTIVE
  Sepsis is the leading cause of intensive care unit (ICU) admission. Plasma Neutrophil Gelatinase Associated-Lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI) detection; however, it is also increased with inflammation and few studies have been conducted in non-Caucasian populations and/or in developing economies. Therefore, we evaluated plasma NGAL's diagnostic performance in the presence of sepsis and systemic inflammatory response syndrome (SIRS) in a Malaysian ICU cohort.
  
  
  METHODS
  This is a prospective observational study on patients with SIRS. Plasma creatinine (pCr) and NGAL were measured on ICU admission. Patients were classified according to the occurrence of AKI and sepsis.
  
  
  RESULTS
  Of 225 patients recruited, 129 (57%) had sepsis of whom 67 (52%) also had AKI. 96 patients (43%) had non-infectious SIRS, of whom 20 (21%) also had AKI. NGAL concentrations were higher in AKI patients within both the sepsis and non-infectious SIRS cohorts (both P < 0.0001). The diagnostic area under curve for AKI was 0.81 (95%CI: 0.74 to 0.87). The optimal cut-off was higher in sepsis compared to non-infectious SIRS patients (454 versus 176 ng/mL). Addition of NGAL to a clinical model comprising age, pCr, medical admission category and SAPS II score increased the mean risk of those with AKI by 4% and reduced the mean risk of those without AKI by 3%.
  
  
  CONCLUSIONS
  Acute kidney injury is more common with sepsis than non-infectious SIRS. Plasma NGAL was diagnostic of AKI in both subgroups. The optimal cut-off for diagnosing AKI was higher in sepsis than in non-infectious SIRS. Addition of plasma NGAL improved the clinical model used to diagnose AKI.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia.
authors.forename: Azrina
authors.initials: A
authors.lastname: Md Ralib
authors.affiliation: Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia.
authors.forename: Mohd Basri
authors.initials: MB
authors.lastname: Mat Nor
authors.affiliation: Department of Medicine, University of Otago Christchurch, New Zealand.
authors.forename: John W
authors.identifier: http://orcid.org/0000-0001-9475-0344
authors.initials: JW
authors.lastname: Pickering
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D000071068:Lipocalin-2 / Q000097:blood*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D003404:Creatinine
keywords: Acute renal failure; clinical nephrology; inflammation; sepsis