Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness

Sean M. Bagshaw, Michael Bennett, Michael Haase, Anja Haase-Fielitz, Moritoki Egi, Hiroshi Morimatsu, Giuseppe D'Amico, Donna Goldsmith, Prasad Devarajan, Rinaldo Bellomo

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251 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)452-461
Number of pages10
JournalIntensive Care Medicine
Volume36
Issue number3
DOIs
Publication statusPublished - Mar 1 2010

Keywords

  • Acute kidney injury
  • Critical illness
  • Fractional excretion of sodium
  • Microscopy
  • Neutrophil gelatinase-associated lipocalin
  • Sepsis
  • Urinary markers

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Bagshaw, S. M., Bennett, M., Haase, M., Haase-Fielitz, A., Egi, M., Morimatsu, H., D'Amico, G., Goldsmith, D., Devarajan, P., & Bellomo, R. (2010). Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Medicine, 36(3), 452-461. https://doi.org/10.1007/s00134-009-1724-9