Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically III Patients: A Post-Hoc Analysis

Mohamud Egal, Hilde de Geus, Johan Groeneveld

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Abstract

Background: Oliguria occurs frequently in critically ill patients, challenging clinicians to distinguish functional adaptation from serum-creatinine-defined acute kidney injury (AKI(sCr)). We investigated neutrophil gelatinase-associated lipocalin (NGAL)'s ability to differentiate between these 2 conditions. Methods: This is a post-hoc analysis of a prospective cohort of adult critically ill patients. Patients without oliguria within the first 6 h of admission were excluded. Plasma and urinary NGAL were measured at 4 h after admission. AKI(sCr) was defined using the AKI network criteria with pre-admission serum creatinine or lowest serum creatinine value during the admission as the baseline value. Hazard ratios for AKI(sCr) occurrence within 72 h were calculated using Cox regression and adjusted for risk factors such as sepsis, pre-admission serum creatinine, and urinary output. Positive predictive values (PPV) and negative predictive values (NPV) were calculated for the optimal cutoffs for NGAL. Results: Oliguria occurred in 176 patients, and 61 (35%) patients developed AKI(sCr). NGAL was a predictor for AKI(sCr) in univariate and multivariate analysis. When NGAL was added to a multivariate model including sepsis, pre-admission serum creatinine and lowest hourly urine output, it outperformed the latter model (plasma p = 0.001; urinary p = 0.048). Cutoff values for AKI(sCr) were 280 ng/ml for plasma (PPV 80%; NPV 79%), and 250 ng/ml for urinary NGAL (PPV 58%; NPV 78%). Conclusions: NGAL can be used to distinguish oliguria due to the functional adaptation from AKI(sCr), directing resources to patients more likely to develop AKI(sCr). (C) 2016 S. Karger AG, Basel
Original languageUndefined/Unknown
Pages (from-to)81-88
Number of pages8
JournalNephron
Volume134
Issue number2
DOIs
Publication statusPublished - 2016

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