Does Whole-Blood Neutrophil Gelatinase-Associated Lipocalin Stratify Acute Kidney Injury in Critically Ill Patients?. (2nd May 2019)

• Record Type: Journal Article
• Authors: Cuartero, M.; Betbesé, A. J.; Núñez, K.; Baldirà, J.; Ordonez-Llanos, J.
• Other Names: Guerrot Dominique Guest Editor.
• Is Part Of: Disease markers. Volume 2019(2019)
• Publication Date: 2019-05-02
• Subjects: Diagnosis -- Periodicals; Biochemical markers -- Periodicals; Pathology -- Periodicals; 616
• DOI: 10.1155/2019/8480925
• Languages: English
• ISSNs: 0278-0240

Abstract

Abstract : Purpose . To analyse the capacity of whole-blood NGAL (wbNGAL) to stratify AKI in critically ill patients with and without sepsis. Methods . Whole-blood NGAL was measured with a point-of-care device at admission and 48 hours later in patients admitted to a general ICU. Patients were classified by the AKIN and KDIGO classifications at admission and 24 and 48 hours. We performed an ROC curve analysis. wbNGAL values at admission were compared in patients with sepsis and septic shock. Results . The study included 100 consecutively admitted patients (40 female) with mean age59.1 ± 17.8 years. Thirty-three patients presented AKI at admission, and 10 more developed it in the next 48 h. Eighteen patients had AKI stage 3, 14 of them at admission. Nine patients required renal replacement therapy. According to KDIGO at admission, wbNGAL values were 78 μ g/L (60-187) in stage 0 (n = 67 ), 263 μ g/L (89-314) in stage 1 (n = 8 ), 484 μ g/L (333-708) in stage 2 (n = 11 ), and 623 μ g/L (231-911) in stage 3 (n = 14 ), p = 0.0001 for trend. Ten patients did not complete 48 hours of study: 6 of 10 were discharged (initial wbNGAL 130 μ g/L (60-514)) and 4 died (773 μ g/L (311-1010)). The AUROC curve of wbNGAL to predict AKI was 0.838 (95% confidence interval 0.76-0.92, p = 0.0001 ), with optimal cut-off value of 178 μ g/L (sensitivity 76.7%, specificity 78.9%, p < 0.0001 ). At admission, twenty-nine patients had sepsis, of whom 20 were in septic shock. wbNGAL concentrations were 81 μ g/L (60-187) in patients without sepsis, 481 (247-687) in those with sepsis, and 623.5 μ g/L (361-798) in the subgroup of septic shock (p < 0.0001 ). Conclusions . Whole-blood NGAL concentration at ICU admission was a good stratifier of AKI in critically ill patients. However, wbNGAL concentrations were higher in septic patients irrespective of AKI occurrence.