Predictability of at-admission Plasma Neutrophil Gelatinase– associated Lipocalin (NGAL) Level for Acute Kidney Injury in Patients admitted to Surgical Intensive Care Unit

Document Type : Original Article

Authors

1 Department of Anesthesia & ICU , Faculty of Medicine, Benha University

2 Department of Medical Biochemistry , Faculty of Medicine, Benha University

3 Department of Clinical Pathology , Faculty of Medicine, Benha University

Abstract

Objectives: To determine the frequency of acute kidney injury (AKI) among patients
admitted to surgical intensive care unit (ICU) for variant indications and to
determine the predictability of at admission AKI biomarkers levels for the possibility
of AKI development. Patients & Methods: The study included 168 patients with mean
age of 53±6.7 years; 97 postoperative patients, 55 trauma patients and 16 patients
had other causes. Patients’ data were collected and disease severity was evaluated
using the Acute Physiology and Chronic Health Evaluation (APACHE II) and the
simplified Therapeutic Intervention Scoring System (TISS-28). Development of AKI
within the first 48 hours after ICU admission was defined according to the Acute
Kidney Injury Network (AKIN) criteria using serum creatinine (sCr). Blood samples
were obtained for ELISA estimation of at admission sCr and serum Cystatin C (CysC)
and plasma Neutrophil gelatinase-associated lipocalin (NGAL) levels. Another blood
sample was obtained at 48 hours of ICU admission for colorimetric estimation of sCr
and then patients’ categorization. Results: Estimated sCr at 48-hr after admission
defined 62 patients developed AKI (36.9%); 39 patients AKI stage-1 (23.2%) and 23
patients AKI stage-2 (13.7%). At admission plasma NGAL levels were significantly
higher in patients compared to controls, however, AKI-free patients showed nonsignificantly
higher plasma NGAL levels compared to controls. Patients developed
AKI had significantly higher plasma NGAL levels compared to AKI-free patients with
significantly higher levels in patients developed AKI-2 compared to those developed
AKI-1. At admission serum CysC levels were significantly higher in patients
compared to controls and in patients developed AKI-2 compared to AKI-free and
AKI-1 patients. Regression and Receiver operating characteristic (ROC) analysis of
at admission clinical and laboratory data as predictors for development of AKI,
defined at admission plasma NGAL and serum CysC, and TISS-28 injury severity
score as the significant specific predictors for possibility of development of AKI.
Conclusion: Patients admitted to surgical ICU had a risk of 36.9% for AKI
development and combined high TISS-28 severity score and high at admission plasma
NGAL levels could early predict the possibility of AKI development with significantly
high specificity.

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