Neutrophil Gelatinase-Associated Lipocalin as a Diagnostic Marker for Acute Kidney Injury in Oliguric Critically III Patients: A Post-Hoc Analysis
| Autor: | Mohamud Egal, Hilde R H de Geus, A. B. Johan Groeneveld |
|---|---|
| Přispěvatelé: | Intensive Care |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Urinary system Critical Illness 030232 urology & nephrology Oliguria urologic and male genital diseases Gastroenterology behavioral disciplines and activities Sepsis 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Lipocalin-2 Internal medicine medicine Humans Prospective Studies Prospective cohort study Aged Creatinine Proportional hazards model business.industry Hazard ratio Acute kidney injury 030208 emergency & critical care medicine Acute Kidney Injury Middle Aged medicine.disease Clinical Practice: Original Paper Surgery chemistry Female medicine.symptom business Biomarkers |
| Zdroj: | Nephron, 134(2), 81-88. Karger |
| ISSN: | 1423-0186 0028-2766 |
| Popis: | Background: Oliguria occurs frequently in critically ill patients, challenging clinicians to distinguish functional adaptation from serum-creatinine-defined acute kidney injury (AKIsCr). 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. AKIsCr 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 AKIsCr 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 AKIsCr. NGAL was a predictor for AKIsCr 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 AKIsCr 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 AKIsCr, directing resources to patients more likely to develop AKIsCr. |
| Databáze: | OpenAIRE |
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