Ata Mahmoodpoor1, Hadi Hamishehkar2, Vahid Fattahi3, Sarvin Sanaie4, Pradeep Arora5, Nader D Nader6. 1. Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2. Applied Drug Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 3. Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran. 4. Lung & Tuberculosis Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 5. Clinical Professor of Medicine, University at Buffalo, Buffalo, NY, USA. Electronic address: Pradeep.arora@va.gov. 6. Department of Anesthesiology, University at Buffalo, 77 Goodell Street, Suite #510, Buffalo, NY 14203, USA. Electronic address: nnader@buffalo.edu.
Abstract
OBJECTIVE: To examine urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL) levels in predicting ICU mortality. DESIGN: Prospective observational. SETTING: University Critical Care setting. PARTICIPANTS: 50 patients with acute kidney injury (AKI). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Serial urinary and plasma concentrations of NGAL were measured. Twenty-five patients had early progression (EP) and 25 patients had early improvement (EI) of AKI. Plasma concentrations of NGAL in the EP group (N=25) were significantly higher than those in the EI group (129 [IQR; 20] vs. 111 [IQR; 32] ng/mL; P=0.009), while urine NGAL levels on admission were similar in both groups (61 [IQR; 20] vs. 65 [IQR; 20] ng/mL; P=0.767). Plasma NGAL concentrations rapidly decreased to 87 [32] ng/mL in the EI group (P<0.001) and while it remained elevated in the EP group (138 [21] ng/mL). Within 28-days, 50% of the patients died in the EP group, whereas no patient died in the EI group (P<0.001). Plasma NGAL was a fair predictor for progression of AKI (AUC; 0.719±0.063; P=0.006). 48-hour changes in plasma NGAL levels predicted death within 28-days of ICU admission (AUC; 0.874±0.048; P<0.001). CONCLUSION: Early progression of AKI was associated with more death within 28 and 90days. While one time measurement of plasma NGAL levels at the time ICU admission may represent the kidney health status in critical care settings, it does not reliably predict mortality. On the other hand, changes in plasma NGAL within 48h of admission improve the value of this biomarker in predicting ICU mortality. Published by Elsevier Inc.
OBJECTIVE: To examine urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL) levels in predicting ICU mortality. DESIGN: Prospective observational. SETTING: University Critical Care setting. PARTICIPANTS: 50 patients with acute kidney injury (AKI). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Serial urinary and plasma concentrations of NGAL were measured. Twenty-five patients had early progression (EP) and 25 patients had early improvement (EI) of AKI. Plasma concentrations of NGAL in the EP group (N=25) were significantly higher than those in the EI group (129 [IQR; 20] vs. 111 [IQR; 32] ng/mL; P=0.009), while urine NGAL levels on admission were similar in both groups (61 [IQR; 20] vs. 65 [IQR; 20] ng/mL; P=0.767). Plasma NGAL concentrations rapidly decreased to 87 [32] ng/mL in the EI group (P<0.001) and while it remained elevated in the EP group (138 [21] ng/mL). Within 28-days, 50% of the patients died in the EP group, whereas no patient died in the EI group (P<0.001). Plasma NGAL was a fair predictor for progression of AKI (AUC; 0.719±0.063; P=0.006). 48-hour changes in plasma NGAL levels predicted death within 28-days of ICU admission (AUC; 0.874±0.048; P<0.001). CONCLUSION: Early progression of AKI was associated with more death within 28 and 90days. While one time measurement of plasma NGAL levels at the time ICU admission may represent the kidney health status in critical care settings, it does not reliably predict mortality. On the other hand, changes in plasma NGAL within 48h of admission improve the value of this biomarker in predicting ICU mortality. Published by Elsevier Inc.