Neutrophil Gelatinase-associated Lipocalin in Adult Septic Patients with and Without Acute Kidney Injury

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2010 Apr 17

PMID 20397003

Citations 115

Authors

Johan Martensson

Max Bell

Anders Oldner

Shengyuan Xu

Per Venge

Claes-Roland Martling

Affiliations

Soon will be listed here.

Abstract

Purpose: To study the impact of inflammation/sepsis on the concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in plasma and urine in adult intensive care unit (ICU) patients and to estimate the predictive properties of NGAL in plasma and urine for early detection of acute kidney injury (AKI) in patients with septic shock.

Methods: Sixty-five patients admitted to the general ICU at the Karolinska University Hospital Solna, Sweden, with normal plasma creatinine were assessed for eligibility. Twenty-seven patients with systemic inflammatory response syndrome (SIRS), severe sepsis, or septic shock without AKI and 18 patients with septic shock and concomitant AKI were included in the final analysis. Plasma and urine were analyzed twice daily for plasma NGAL (pNGAL), C-reactive protein (CRP), procalcitonin, myeloperoxidase, plasma cystatin C, plasma creatinine, urine NGAL (uNGAL), urine cystatin C, and urine alpha1-microglobulin.

Results: Of the 45 patients, 40 had elevated peak levels of pNGAL. Peak levels of pNGAL were not significantly different between septic shock patients with and without AKI. Peak levels of uNGAL were below the upper reference limit in all but four patients without AKI. uNGAL was a good predictor (area under ROC 0.86) whereas pNGAL was a poor predictor (area under ROC 0.67) for AKI within the next 12 h in patients with septic shock.

Conclusions: pNGAL is raised in patients with SIRS, severe sepsis, and septic shock and should be used with caution as a marker of AKI in ICU patients with septic shock. uNGAL is more useful in predicting AKI as the levels are not elevated in septic patients without AKI.

Citing Articles

Development and validation of an early acute kidney injury risk prediction model for patients with sepsis in emergency departments.

Lin C, Lin S, Zheng M, Cai K, Wang J, Luo Y Ren Fail. 2024; 46(2):2419523.

PMID: 39477816 PMC: 11533258. DOI: 10.1080/0886022X.2024.2419523.

Lipocalin-2 Serum Levels in Rheumatoid Arthritis Patients Treated with Adalimumab and Its Correlation with Proinflammatory Factors.

Conde-Aranda J, Scotece M, Varela-Garcia M, Torrijos-Pulpon C, Arosa L, Camba-Gomez M Mediators Inflamm. 2024; 2024:7264704.

PMID: 39403549 PMC: 11473169. DOI: 10.1155/2024/7264704.

The Road to Precision Medicine for Acute Kidney Injury.

Birkelo B, Koyner J, Ostermann M, Bhatraju P Crit Care Med. 2024; 52(7):1127-1137.

PMID: 38869385 PMC: 11250999. DOI: 10.1097/CCM.0000000000006328.

Sepsis, Management & Advances in Metabolomics.

Pandey S Nanotheranostics. 2024; 8(3):270-284.

PMID: 38577320 PMC: 10988213. DOI: 10.7150/ntno.94071.

Mortality Analysis in Geriatric Patients With Acute Kidney Injury Admitted in the Intensive Care Unit: A Single-Center Cross-Sectional Study.

Kumthekar G, Purandare V, Nagarkar M, Paramshetti S Cureus. 2024; 16(2):e54509.

PMID: 38516467 PMC: 10955431. DOI: 10.7759/cureus.54509.

References

Bagshaw S, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H . Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med. 2009; 36(3):452-61. DOI: 10.1007/s00134-009-1724-9. View

Strevens H, Wide-Swensson D, Grubb A, Hansen A, Horn T, Ingemarsson I . Serum cystatin C reflects glomerular endotheliosis in normal, hypertensive and pre-eclamptic pregnancies. BJOG. 2003; 110(9):825-30. View

Nickolas T, ORourke M, Yang J, Sise M, Canetta P, Barasch N . Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med. 2008; 148(11):810-9. PMC: 2909852. DOI: 10.7326/0003-4819-148-11-200806030-00003. View

Axelsson L, Bergenfeldt M, Ohlsson K . Studies of the release and turnover of a human neutrophil lipocalin. Scand J Clin Lab Invest. 1995; 55(7):577-88. DOI: 10.3109/00365519509110257. View

Bokenkamp A, Laarman C, Braam K, van Wijk J, Kors W, Kool M . Effect of corticosteroid therapy on low-molecular weight protein markers of kidney function. Clin Chem. 2008; 53(12):2219-21. DOI: 10.1373/clinchem.2007.094946. View

Mishra J, Dent C, Tarabishi R, Mitsnefes M, Ma Q, Kelly C . Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet. 2005; 365(9466):1231-8. DOI: 10.1016/S0140-6736(05)74811-X. View

Zappitelli M, Washburn K, Arikan A, Loftis L, Ma Q, Devarajan P . Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care. 2007; 11(4):R84. PMC: 2206519. DOI: 10.1186/cc6089. View

Bellomo R, Ronco C, Kellum J, Mehta R, Palevsky P . Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8(4):R204-12. PMC: 522841. DOI: 10.1186/cc2872. View

Uchino S, Kellum J, Bellomo R, Doig G, Morimatsu H, Morgera S . Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005; 294(7):813-8. DOI: 10.1001/jama.294.7.813. View

10.

Cruz D, De Cal M, Garzotto F, Perazella M, Lentini P, Corradi V . Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population. Intensive Care Med. 2009; 36(3):444-51. PMC: 2820221. DOI: 10.1007/s00134-009-1711-1. View

11.

Mori K, Lee H, Rapoport D, Drexler I, Foster K, Yang J . Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest. 2005; 115(3):610-21. PMC: 548316. DOI: 10.1172/JCI23056. View

12.

Xu S, Carlson M, Engstrom A, Garcia R, PETERSON C, Venge P . Purification and characterization of a human neutrophil lipocalin (HNL) from the secondary granules of human neutrophils. Scand J Clin Lab Invest. 1994; 54(5):365-76. DOI: 10.3109/00365519409088436. View

13.

Fjaertoft G, Foucard T, Xu S, Venge P . Human neutrophil lipocalin (HNL) as a diagnostic tool in children with acute infections: a study of the kinetics. Acta Paediatr. 2005; 94(6):661-6. DOI: 10.1111/j.1651-2227.2005.tb01961.x. View

14.

Brunkhorst F, Wegscheider K, Forycki Z, Brunkhorst R . Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med. 2008; 26 Suppl 2:S148-52. DOI: 10.1007/BF02900728. View

15.

Dent C, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Barasch J . Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study. Crit Care. 2007; 11(6):R127. PMC: 2246223. DOI: 10.1186/cc6192. View

16.

Hirsch R, Dent C, Pfriem H, Allen J, Beekman 3rd R, Ma Q . NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol. 2007; 22(12):2089-95. DOI: 10.1007/s00467-007-0601-4. View

17.

Bernard G, Vincent J, Laterre P, LaRosa S, Dhainaut J, Lopez-Rodriguez A . Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med. 2001; 344(10):699-709. DOI: 10.1056/NEJM200103083441001. View

18.

Tuladhar S, Puntmann V, Soni M, Punjabi P, Bogle R . Rapid detection of acute kidney injury by plasma and urinary neutrophil gelatinase-associated lipocalin after cardiopulmonary bypass. J Cardiovasc Pharmacol. 2009; 53(3):261-6. DOI: 10.1097/FJC.0b013e31819d6139. View

19.

Makris K, Markou N, Evodia E, Dimopoulou E, Drakopoulos I, Ntetsika K . Urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients. Clin Chem Lab Med. 2008; 47(1):79-82. DOI: 10.1515/CCLM.2009.004. View

20.

Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A . Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003; 31(6):1737-41. DOI: 10.1097/01.CCM.0000063440.19188.ED. View