Plasma neutrophil gelatinase-associated lipocalin best diagnosed acute kidney injury in patients with systemic inflammatory response syndrome and sepsis
Introduction: Sepsis is the leading cause of ICU admission. About 60% of patients with severe sepsis had acute kidney injury (AKI). To date, plasma Neutrophil-Gelatinase Associated Lipocalin (NGAL) is the most promising biomarker for AKI, however it is also increased with inflammation and infection....
| Main Authors: | , , , |
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| Format: | Conference or Workshop Item |
| Language: | English |
| Published: |
2015
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| Online Access: | http://irep.iium.edu.my/43427/ http://irep.iium.edu.my/43427/1/MSA_NGAL_AZRINA.pdf |
| Summary: | Introduction: Sepsis is the leading cause of ICU admission. About 60% of patients with severe sepsis had acute kidney injury (AKI). To date, plasma Neutrophil-Gelatinase Associated Lipocalin (NGAL) is the most promising biomarker for AKI, however it is also increased with inflammation and infection.
Objectives: We aim to evaluate the utility of NGAL, Procalcitonin (PCT) and Interleukin-6 (IL-6) for AKI and sepsis.
Methods: This is an interim analysis of a prospective observational study of adult ICU patients with systemic inflammatory response syndroem (SIRS). PCT was measured using BRAHMS Kryptor compact assay, NGAL using TriageMeter, IL-6 using ELISA technique, and creatinine using Olympus AU2700TM analyser. Patients were classified according to the occurrence of AKI and sepsis.
Results: Of the 115 patients, 62 (54%) had AKI, of which 43 (69%) had sepsis, and in 19 (31%) non-infectious SIRS. NGAL and PCT were higher in patients with AKI-SIRS compared to No AKI-SIRS (p=0.001 and p=0.02, respectively), and in AKI-Sepsis compared to No AKI-Sepsis (p<0.0001 and p=0.001, respectively). However, there were no differences in plasma IL-6. NGAL had the highest AUC in diagnosing AKI (0.78 (0.69 to 0.86)). The AUC of NGAL in diagnosing AKI was 0.80 (0.66 to 0.93) in SIRS, and 0.76 (0.65 to 0.87) in sepsis. The optimal cut-off point was 84 ng/ml in SIRS and 256 ng/ml in sepsis. Addition of NGAL to the reference model, which includes age, weight, and SAPSII score, showed the largest improvement in risk assessment; with total IDI of 0.09 (0.02 to 0.28).
Conclusions: AKI is more common in sepsis patients. Of the biomarkers measured, NGAL had the highest diagnostic performance for AKI. The optimal cut-off point for diagnosing AKI in sepsis was higher than in non-infectious SIRS. The addition of NGAL improved the clinical model incorporating age, illness severity and weight in diagnosing AKI.
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