Plasma neutrophil gelatinase associated lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis

Md Ralib, Azrina and Mat Nor, Mohd Basri and Pickering, John W. (2017) Plasma neutrophil gelatinase associated lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis. Nephrology, 22 (5). pp. 412-419. E-ISSN 1440-1797

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Abstract

Aim: Sepsis is the leading cause of ICU admission. Plasma NGAL is a promising biomarker for AKI detection, however it is also increased with inflammation and few studies have been conducted in non-caucasion populations and/or in developing economies. Therefore, we evaluated plasma NGAL’s diagnostic performance in the presence of sepsis and systemic inflammatory response syndrome (SIRS) in a Malaysian ICU cohort. Methods: This is a prospective observational study on patients with SIRS. Plasma creatinine (pCr) and NGAL were measured on ICU admission. Patients were classified according to the occurrence of AKI and sepsis. Results: Of 225 patients recruited, 129 (57%) had sepsis of whom 67 (52%) also had AKI. 96 patients (43%) had non-infectious SIRS, of whom 36 (21%) also had AKI. NGAL concentrations were higher in AKI patients within both the sepsis and non-infectious SIRS cohorts (both p<0.0001). The diagnostic area under curve for AKI was 0.81 (95%CI: 0.74 to 0.87). The optimal cut-off was higher in sepsis compared to non-infectious SIRS patients (454 versus 176 ng/ml). Addition of NGAL to a clinical model comprising age, pCr, medical admission category and SAPS II score increased the mean risk of those with AKI by 4% and reduced the mean risk of those without AKI by 3%. Conclusions: AKI is more common with sepsis than non-infectious SIRS. Plasma NGAL was diagnostic of AKI in both subgroups. The optimal cut-off for diagnosing AKI was higher in sepsis Nephrology than in non-infectious SIRS. Addition of plasma NGAL improved the clinical model used to diagnose AKI

Item Type:	Article (Journal)
Additional Information:	3439/50448
Uncontrolled Keywords:	Acute Renal Failure (ARF);Sepsis;Inflammation;Clinical Nephrology
Subjects:	R Medicine > R Medicine (General)
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	Prof Azrina Md Ralib
Date Deposited:	07 Jun 2016 10:41
Last Modified:	10 Jan 2018 16:39
URI:	http://irep.iium.edu.my/id/eprint/50448

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