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Serum neutrophil gelatinase-associated lipocalin at inception of renal replacement therapy predicts survival in critically ill patients with acute kidney injury.

Kümpers P, Hafer C, Lukasz A, Lichtinghagen R, Brand K, Fliser D, Faulhaber-Walter R, Kielstein JT - Crit Care (2010)

Bottom Line: NGAL levels were higher in non-survivors (430 [303-942] ng/mL) compared to survivors (298 [159-506] ng/mL; P = 0.004).Consistently, Cox proportional hazards regression analysis identified NGAL as a strong independent predictor for 28-day survival (hazard ratio 1.6 (95% confidence interval [CI] 1.15 - 2.23), P = 0.005).The results from this study indicate that serum NGAL is as an independent predictor of 28-day mortality in ICU patients with dialysis-dependent AKI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625, Hannover, Germany. pkuempers@gmx.de

ABSTRACT

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is a promising novel biomarker that correlates with the severity and outcome of acute kidney injury (AKI). However, its prognostic utility during the late course of AKI, especially in patients that require renal replacement therapy (RRT) remains unknown. The aim of this study was to evaluate the predictive value of serum NGAL in patients with established AKI at inception of RRT in the intensive care unit (ICU).

Methods: Serum NGAL (ELISA methodology) was measured in 109 critically ill patients with AKI at inception of RRT in 7 ICUs of a tertiary care university hospital. The primary outcome studied was 28-day mortality. Secondary outcome measures were ICU length of stay, ventilator-free days, and renal recovery at day 28.

Results: There was a significant difference in serum NGAL between healthy subjects (median [interquartile range] 39.0 [37.5-42.75] ng/mL), critically ill patients with systemic inflammatory response syndrome (SIRS) (297 [184-490] ng/mL), and critically ill patients with sepsis (708 [365-1301] ng/mL; P < 0.0001), respectively. Multiple linear regression showed that NGAL levels were independently related to the severity of AKI and the extent of systemic inflammation. NGAL levels were higher in non-survivors (430 [303-942] ng/mL) compared to survivors (298 [159-506] ng/mL; P = 0.004). Consistently, Cox proportional hazards regression analysis identified NGAL as a strong independent predictor for 28-day survival (hazard ratio 1.6 (95% confidence interval [CI] 1.15 - 2.23), P = 0.005).

Conclusions: This is the first prospective evaluation of serum NGAL as an outcome-specific biomarker in critically ill patients at initiation of RRT. The results from this study indicate that serum NGAL is as an independent predictor of 28-day mortality in ICU patients with dialysis-dependent AKI.

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Survival to day 28 according to serum NGAL. Kaplan-Meier curves of 28-day survival stratified to (a) neutrophil gelatinase-associated lipocalin (NGAL) quartiles (Q) (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.003), and (b) Sequential Organ Failure Assessment (SOFA) quartiles (total SOFA), respectively (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.002) at inception of renal replacement therapy in critically ill patients with acute kidney injury (n = 109).
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Figure 2: Survival to day 28 according to serum NGAL. Kaplan-Meier curves of 28-day survival stratified to (a) neutrophil gelatinase-associated lipocalin (NGAL) quartiles (Q) (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.003), and (b) Sequential Organ Failure Assessment (SOFA) quartiles (total SOFA), respectively (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.002) at inception of renal replacement therapy in critically ill patients with acute kidney injury (n = 109).

Mentions: When visualized by Kaplan-Meier curves, mortality was no different between NGAL quartile (Q) 1 and Q2, but steadily increased among Q3 and Q4 (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.003; Figure 2a). Similarly, 28-day mortality was low in the SOFA Q1, intermediate in Q2 and Q3, and high in SOFA Q4, respectively (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.002; Figure 2b).


Serum neutrophil gelatinase-associated lipocalin at inception of renal replacement therapy predicts survival in critically ill patients with acute kidney injury.

Kümpers P, Hafer C, Lukasz A, Lichtinghagen R, Brand K, Fliser D, Faulhaber-Walter R, Kielstein JT - Crit Care (2010)

Survival to day 28 according to serum NGAL. Kaplan-Meier curves of 28-day survival stratified to (a) neutrophil gelatinase-associated lipocalin (NGAL) quartiles (Q) (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.003), and (b) Sequential Organ Failure Assessment (SOFA) quartiles (total SOFA), respectively (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.002) at inception of renal replacement therapy in critically ill patients with acute kidney injury (n = 109).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875521&req=5

Figure 2: Survival to day 28 according to serum NGAL. Kaplan-Meier curves of 28-day survival stratified to (a) neutrophil gelatinase-associated lipocalin (NGAL) quartiles (Q) (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.003), and (b) Sequential Organ Failure Assessment (SOFA) quartiles (total SOFA), respectively (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.002) at inception of renal replacement therapy in critically ill patients with acute kidney injury (n = 109).
Mentions: When visualized by Kaplan-Meier curves, mortality was no different between NGAL quartile (Q) 1 and Q2, but steadily increased among Q3 and Q4 (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.003; Figure 2a). Similarly, 28-day mortality was low in the SOFA Q1, intermediate in Q2 and Q3, and high in SOFA Q4, respectively (Log-rank (Mantel-Cox) P = 0.01; Log-rank test for trend P = 0.002; Figure 2b).

Bottom Line: NGAL levels were higher in non-survivors (430 [303-942] ng/mL) compared to survivors (298 [159-506] ng/mL; P = 0.004).Consistently, Cox proportional hazards regression analysis identified NGAL as a strong independent predictor for 28-day survival (hazard ratio 1.6 (95% confidence interval [CI] 1.15 - 2.23), P = 0.005).The results from this study indicate that serum NGAL is as an independent predictor of 28-day mortality in ICU patients with dialysis-dependent AKI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625, Hannover, Germany. pkuempers@gmx.de

ABSTRACT

Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) is a promising novel biomarker that correlates with the severity and outcome of acute kidney injury (AKI). However, its prognostic utility during the late course of AKI, especially in patients that require renal replacement therapy (RRT) remains unknown. The aim of this study was to evaluate the predictive value of serum NGAL in patients with established AKI at inception of RRT in the intensive care unit (ICU).

Methods: Serum NGAL (ELISA methodology) was measured in 109 critically ill patients with AKI at inception of RRT in 7 ICUs of a tertiary care university hospital. The primary outcome studied was 28-day mortality. Secondary outcome measures were ICU length of stay, ventilator-free days, and renal recovery at day 28.

Results: There was a significant difference in serum NGAL between healthy subjects (median [interquartile range] 39.0 [37.5-42.75] ng/mL), critically ill patients with systemic inflammatory response syndrome (SIRS) (297 [184-490] ng/mL), and critically ill patients with sepsis (708 [365-1301] ng/mL; P < 0.0001), respectively. Multiple linear regression showed that NGAL levels were independently related to the severity of AKI and the extent of systemic inflammation. NGAL levels were higher in non-survivors (430 [303-942] ng/mL) compared to survivors (298 [159-506] ng/mL; P = 0.004). Consistently, Cox proportional hazards regression analysis identified NGAL as a strong independent predictor for 28-day survival (hazard ratio 1.6 (95% confidence interval [CI] 1.15 - 2.23), P = 0.005).

Conclusions: This is the first prospective evaluation of serum NGAL as an outcome-specific biomarker in critically ill patients at initiation of RRT. The results from this study indicate that serum NGAL is as an independent predictor of 28-day mortality in ICU patients with dialysis-dependent AKI.

Show MeSH
Related in: MedlinePlus