IntroductionNeutrophil gelatinase-associated lipocalin (NGAL) has been demonstrated to be a useful early diagnostic biomarker of acute kidney injury (AKI) where the timing of the insult is certain. However, NGAL is not well validated in adult critical care practice because of indeterminate timing of injury. Therefore, we sought to establish the predictive ability of both urine and plasma NGAL to detect AKI in ICU patients.MethodThis prospective observational study was performed in a busy large district general hospital mixed surgical-medical ICU in Reading, UK. Consecutive adult admissions to the ICU, with absence of chronic kidney disease, renal transplant or AKI as defined by RIFLE criteria were included. Blood and urine specimens were collected at admission and every 24 hours until 72 hours and tested for NGAL. The purpose of the study was to assess whether urinary NGAL (uNGAL) or plasma NGAL (pNGAL) can predict the occurrence of AKI at an earlier point of time than the conventional markers, that is creatinine and urine output as is used in RIFLE criteria.ResultsOver a 12-month period, 194 patients were enrolled. In total, 59 (30.4%) patients developed AKI. The admission pNGAL and uNGAL were significantly higher in the patients who developed AKI compared to the non-AKI patients (436 ng/mL (240, 797) versus 168 ng/mL (121.3, 274.3) P <0.001 and 342 ng/mL (61.5, 1,280) versus 34.5 ng/mL (11.5, 107.75) P <0.001 respectively). Hospital mortality was higher in the AKI group (17% versus 4%). Plasma NGAL performed fairly on admission (AUROC 0.77) and thereafter performance improved at 24 and 48 hours (AUROC 0.88 and 0.87) following ICU admission. Urine NGAL had a fair predictive value on admission (AUROC 0.79) and at 24 hours (AUROC 0.78) and was good at 48 hours (AUROC 0.82).ConclusionsIn critically ill patients without pre-existing kidney disease, both pNGAL and uNGAL measured at admission can predict AKI (defined by RIFLE criteria) occurrence up to 72 hours post-ICU admission and their performance (AUROC) was fair. The accuracy of NGAL appeared to improve slightly as patients progressed through their ICU stay. Serial measurements of NGAL (both pNGAL and uNGAL) may be of added value in an ICU setting to predict the occurrence of AKI.
Cognitive development in congenital hypothyroidism: is overtreatment a greater threat than undertreatment?Bongers-Schokking JJ, Resing WC, de Rijke YB, et al. J Clin Endocrinol Metab 2013; 98: 4499-4506. The ideal treatment of patients with congenital hypothyroidism (CHT) is currently debated, with some advocating optimization of FT4, and others focusing on TSH. It is known that cognitive development is negatively affected in untreated CHT, but the comparative impact of undertreatment and overtreatment has not been widely investigated.This prospective, longitudinal study investigated the cognitive development of children with early treated CHT in the Netherlands. Sixty-one patients were psychologically evaluated at 1.8 years (mental development index), 6 years (intelligence quotient (IQ)) and 11 years of age (IQ). Individualized optimal FT4 and TSH steady state concentrations (SSCs) were used as targets. These were determined using the mean of a series of measurements under euthyroid conditions for each patient; undertreatment or overtreatment was defined as >AE2SDs of the SSC for each analyte. The rationale for use of SSCs was that the normal TFT reference ranges were too wide.The key finding was that overtreatment, as defined by FT4, caused a mean decline in IQ aged 11 of 16.0 points (P¼0.005) compared to no FT4 overtreatment. Interestingly, this effect was not apparent at lower ages. Furthermore, normal development at all ages was achieved if patients were undertreated, as long as overtreatment did not also occur.The authors concluded that overtreatment appears to be harmful to cognitive outcome in CHT, and also that FT4 is most useful for guiding therapy, as the lower limit of TSH (0.05 mU/L) may be too low to identify all episodes of overtreatment. They propose using individualized reference ranges for FT4, although a method of implementation in the clinical setting is not mentioned.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.