Serum neutrophil gelatinase-associated lipocalin as a predictor of acute kidney injury in critically-ill neonates.

Early detection of evolving Acute Kidney Injury (AKI) in critically ill neonates can lead to better preventive and therapeutic interventions. Neutrophil Gelatinase-associated Lipocalin (NGAL) is a promising biomarker of AKI, which was also shown to increase in inflammation. The objective of this study was to assess the utility of serum NGAL (sNGAL) as an early marker of evolving AKI in critically-ill neonates with and without sepsis. sNGAL levels were estimated in 60 critically-ill neonates at the time of admission to Neonatal Intensive Care Unit (NICU), in comparison to 20 healthy matched control. Patients were categorized as sepsis (n = 35) and no-sepsis (n = 25) subgroups on basis of clinical and laboratory criteria. They were subsequently discriminated according to creatinine and urine output criteria of the Acute Kidney Injury Network (AKIN), into AKI (n = 34) and no-AKI (n = 26) subgroups, sNGAL levels were significantly higher in the patient group as compared to control (132.7 +/- 67.8 vs. 55 +/- 10.3 ng mL(-1), p = 0.0001). Elevated levels were comparable between sepsis and no-sepsis groups (130.1 +/- 69.4 vs. 136.5 +/- 66.6 ng mL(-1), p = 0.7) and they positively correlated with 48-hour post-admission serum creatinine (p = 0.0001). Patients of AKI group had significantly higher sNGAL than those of no-AKI group (176.2 +/- 55.9 vs. 75.9 +/- 28.3 ng mL(-1), p = 0.0001). A cut-off value for sNGAL of 117.5 ng mL(-1), was predictive of AKI with a sensitivity of 82% and a specificity of 88.5%. It could be speculated that measurement of serum NGAL can serve as a clinically useful marker for early prediction of evolving AKI in critically-ill neonates with and without sepsis.