scholarly journals Plasma neutrophil gelatinase-associated lipocalin at intensive care unit admission as a predictor of acute kidney injury progression

2020 ◽  
Vol 13 (6) ◽  
pp. 994-1002 ◽  
Author(s):  
Jacqueline Koeze ◽  
Iwan C C van der Horst ◽  
Frederik Keus ◽  
Renske Wiersema ◽  
Wim Dieperink ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Roc Curve ◽  
Kidney Injury ◽  
Operating Characteristics ◽  
Icu Admission ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Plasma Ngal ◽  
Neutrophil Gelatinase

Abstract Background Acute kidney injury (AKI) is a common complication in patients during intensive care unit (ICU) admission. AKI is defined as an increase in serum creatinine (SCr) and/or a reduction in urine output. SCr is a marker of renal function with several limitations, which led to the search for biomarkers for earlier AKI detection. Our aim was to study the predictive value of plasma neutrophil gelatinase-associated lipocalin (NGAL) at admission as a biomarker for AKI progression during the first 48 h of ICU admission in an unselected, heterogeneous ICU patient population. Methods We conducted a prospective observational study in an academic tertiary referral ICU population. We recorded AKI progression in all ICU patients during the first 48 h of ICU admission in a 6-week period. Plasma NGAL was measured at admission but levels were not reported to the attending clinicians. As possible predictors of AKI progression, pre-existing AKI risk factors were recorded. We examined the association of clinical parameters and plasma NGAL levels at ICU admission with the incidence and progression of AKI within the first 48 h of the ICU stay. Results A total of 361 patients were included. Patients without AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 115 ng/mL [interquartile range (IQR) 81–201]. Patients with AKI progression during the first 48 h of ICU admission had median NGAL levels at admission of 156 ng/mL (IQR 97–267). To predict AKI progression, a multivariant model with age, sex, diabetes mellitus, body mass index, admission type, Acute Physiology and Chronic Health Evaluation score and SCr at admission had an area under the receiver operating characteristics (ROC) curve of 0.765. Adding NGAL to this model showed a small increase in the area under the ROC curve to 0.783 (95% confidence interval 0.714–0.853). Conclusions NGAL levels at admission were higher in patients with progression of AKI during the first 48 h of ICU admission, but adding NGAL levels at admission to a model predicting this AKI progression showed no significant additive value.

Neutrophil gelatinase-associated lipocalin is a better biomarker than cystatin C for the prediction of imminent acute kidney injury in critically ill patients

2017 ◽  
Vol 55 (2) ◽  
pp. 190-197 ◽  
Author(s):  
Itir Yegenaga ◽  
Fatih Kamis ◽  
Canan Baydemir ◽  
Elizade Erdem ◽  
Koray Celebi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Cystatin C ◽  
Kidney Injury ◽  
Failure Criteria ◽  
Serum Cystatin C ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Aims The prevention of acute kidney injury can be lifesaving for the intensive care unit patients. However, conventional methods are not sufficient for the prediction of the risk of future acute kidney injury. In this study, the promising biomarker, neutrophil gelatinase-associated lipocalin, was compared with cystatin C as an indicator for the risk of future acute kidney injury. Methods One hundred and eighty-three adult patients without chronic kidney disease or renal replacement therapy were included in this study. The plasma and urine concentrations of neutrophil gelatinase-associated lipocalin and cystatin C were assessed on the second day after intensive care unit admission and were followed for seven days to monitor the development of acute kidney injury. Acute kidney injury diagnosis was based on the risk, injury, failure, loss, end-stage renal failure criteria. Results Thirty-four per cent of the patients had acute kidney injury; 17 patients who did not fulfil criteria at the beginning, developed acute kidney injury from days 3 to 7 after admission. The mean serum creatinine on admission did not significantly differ between this and control groups (0.72 ± 0.20 and 0.83 ± 0.21; P = 0.060); however, the serum and urinary neutrophil gelatinase-associated lipocalin concentrations on the second day were significantly different (median: 75.69 [54.18–91.18] and 123.68 [90.89–166.31], P = 0.001; and median: 17.60 [8.56–34.04] and 61.37 [24.59–96.63], P = 0.001). Notably, the 48-h serum cystatin C concentration did not differ. Conclusion Neutrophil gelatinase-associated lipocalin concentrations in the urine and serum on the second day of intensive care unit admission could be used to predict the development of acute kidney injury in the following three to seven days in the intensive care unit; however, the cystatin C concentration did not have predictive value.

Influence of patients’ clinical features at intensive care unit admission on performance of cell cycle arrest biomarkers in predicting acute kidney injury

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Bo Yang ◽  
Yun Xie ◽  
Francesco Garzotto ◽  
Ghada Ankawi ◽  
Alberto Passannante ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Clinical Features ◽  
Kidney Injury ◽  
Roc Curves ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Operating Characteristics ◽  
Icu Admission ◽  
Cycle Arrest

AbstractObjectivesIdentification of acute kidney injury (AKI) can be challenging in patients with a variety of clinical features at intensive care unit (ICU) admission, and the capacity of biomarkers in this subpopulation has been poorly studied. In our study we examined the influence that patients’ clinical features at ICU admission have over the predicting ability of the combination of urinary tissue inhibitor of metalloproteinase-2 (TIMP2) and insulin-like growth factor binding protein 7 (IGFBP7).MethodsUrinary [TIMP2]•[IGFBP7] were measured for all patients upon admission to ICU. We calculated the receiver operating characteristics (ROC) curves for AKI prediction in the overall cohort and for subgroups of patients according to etiology of ICU admission, which included: sepsis, trauma, neurological conditions, cardiovascular diseases, respiratory diseases, and non-classifiable causes.ResultsIn the overall cohort of 719 patients, 239 (33.2%) developed AKI in the first seven days. [TIMP2]•[IGFBP7] at ICU admission were significantly higher in AKI patients than in non-AKI patients. This is true not only for the overall cohort but also in the other subgroups. The area under the ROC curve (AUC) for [TIMP2]•[IGFBP7] in predicting AKI in the first seven days was 0.633 (95% CI 0.588–0.678), for the overall cohort, with sensitivity and specificity of 66.1 and 51.9% respectively. When we considered patients with combined sepsis, trauma, and respiratory disease we found a higher AUC than patients without these conditions (0.711 vs. 0.575; p=0.002).ConclusionsThe accuracy of [TIMP2]•[IGFBP7] in predicting the risk of AKI in the first seven days after ICU admission has significant variability when the reason for ICU admission is considered.

scholarly journals Serum Neutrophil Gelatinase-associated Lipocalin Measured at Admission to Predict Mortality in Sepsis-associated Acute Kidney Injury of Vietnamese Critically Ill Patients

2018 ◽  
Vol 11 (1) ◽  
pp. 100-108 ◽  
Author(s):  
Le V. Thang ◽  
Pham N. H. Tuan ◽  
Nguyen T. Kien ◽  
Nguyen T. T. Dung ◽  
Nguyen T. Tue ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Lipocalin 2 ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Septic Acute Kidney Injury ◽  
Predict Hospital Mortality ◽  
Neutrophil Gelatinase

Purpose: To evaluate incidence of sepsis-associated acute kidney injury (SA-AKI) in the AKI Intensive Care Unit (ICU) patients and predictive value of Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at the admission in mortality of SA-AKI and non SA-AKI. Patients and Methods: A study of 101 consecutive adult patients admitted to the Intensive Care Unit (ICU) diagnosed as AKI in which there were 60 patients with SA-AKI. Acute kidney injury was defined based on Acute Kidney Injury Network (AKIN) criteria. Serum NGAL was measured using the BioVendor Human Lipocalin-2/NGAL ELISA with blood sample taken at admission. Results: Incidence of septic acute kidney injury was 59.4%, incidence of death patients reached 20.0%. Mean concentration of serum NGAL in death group was 633.56 ng/ml, higher significantly than that of survival patients (328.84 ng/ml), p<0.005. Serum NGAL in non SA-AKI patients showed a better prognostic value to predict hospital mortality than that in SA-AKI patients (AUC: 0.894 and 0,807 respectively; p < 0.005) Conclusion: In SA-AKI patients, serum NGAL and mortality rate increased along with the stage of AKI. Serum NGAL, measuring at admission time, was a good prognostic biomarker of mortality in both SA-AKI and non SA-AKI patients.

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