TY - JOUR
T1 - Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness
AU - Bagshaw, Sean M.
AU - Bennett, Michael
AU - Haase, Michael
AU - Haase-Fielitz, Anja
AU - Egi, Moritoki
AU - Morimatsu, Hiroshi
AU - D'Amico, Giuseppe
AU - Goldsmith, Donna
AU - Devarajan, Prasad
AU - Bellomo, Rinaldo
PY - 2010/3/1
Y1 - 2010/3/1
N2 - Objective: Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI. Design: Prospective observational study. Setting: Two adult ICUs in Melbourne, Australia. Patients: Critically ill patients with septic and non-septic AKI. Interventions: None. Measurements and main results: Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82). Conclusion: Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.
AB - Objective: Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI. Design: Prospective observational study. Setting: Two adult ICUs in Melbourne, Australia. Patients: Critically ill patients with septic and non-septic AKI. Interventions: None. Measurements and main results: Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82). Conclusion: Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.
KW - Acute kidney injury
KW - Critical illness
KW - Fractional excretion of sodium
KW - Microscopy
KW - Neutrophil gelatinase-associated lipocalin
KW - Sepsis
KW - Urinary markers
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U2 - 10.1007/s00134-009-1724-9
DO - 10.1007/s00134-009-1724-9
M3 - Article
C2 - 19956924
AN - SCOPUS:77951208316
VL - 36
SP - 452
EP - 461
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 3
ER -