Concentrations of neutrophil gelatinase‐associated lipocalin are increased in serum and peritoneal fluid from horses with inflammatory abdominal disease and non‐strangulating intestinal infarctions

Abstract

Background Neutrophil gelatinase‐associated lipocalin (NGAL) is produced in response to inflammation in horses, but it has not yet been investigated as a biomarker in horses with the abdominal disease. Objectives To investigate NGAL in serum and peritoneal fluid in horses with the abdominal disease. Study design Retrospective clinical study. Methods Data from medical records of 270 horses admitted with acute abdominal disease (simple obstructions [n = 43], strangulating obstructions [n = 104], inflammatory abdominal disease [n = 99], non‐strangulating intestinal infarction [NSII, n = 24]) and 9 healthy control horses were reviewed, and serum and peritoneal fluid samples were retrieved from a biobank. NGAL was measured in serum and peritoneal fluid by ELISA. Differences in NGAL concentrations between groups were assessed. Results Healthy horses had low serum and peritoneal fluid concentrations of NGAL (median = 21.0 and 9.5 μg/L, respectively). Neither serum nor peritoneal fluid NGAL concentrations (median serum, peritoneal fluid) differed between healthy horses and horses with simple (28.1 μg/L, 13.0 μg/L) and strangulating intestinal obstructions (34.7 μg/L, 38.4 μg/L). Horses with NSII (308.0 μg/L, 2163.0 μg/L) and inflammatory abdominal disease (171.1 μg/L, 314.1 μg/L) had higher serum and peritoneal fluid concentrations of NGAL than the other groups (p < 0.001). Peritoneal fluid NGAL concentrations in horses with NSII were higher than in horses with inflammatory abdominal disease (p = 0.03). Main limitations Retrospective study design; small group of control horses. Conclusions NGAL is a marker of inflammation in horses with the abdominal disease. The high peritoneal fluid concentration of NGAL in horses with NSII compared to all other groups may render NGAL useful for identifying this condition, which is otherwise difficult to differentiate from other types of peritonitis. Thereby, NGAL may potentially facilitate timely surgical intervention in this group of patients. The results of this study must be evaluated in larger, and preferably prospective, studies to obtain a more comprehensive evaluation of the diagnostic utility of NGAL.

Clinical insights: Clinicopathological parameters for diagnosing and predicting outcome of horses with colic

“…Conversely, there was no significant difference in NGAL concentration between healthy horses and horses with simple or strangulating obstruction. 35 It was also found that NGAL concentration in serum was significantly higher in horses with a longer pre-admission duration of colic and was positively correlated with the concentration of SAA (r = 0.8) and fibrinogen (r = 0.5) and negatively correlated with serum iron (r = À0.5) and white blood cell count (r = À0.3). Based on these results, 35 NGAL would not be useful for differentiating horses with strangulating obstruction from horses that could be managed medically or from horses with enteritis from horses with a nonstrangulating intestinal infarction.…”

“…In a study using banked serum and peritoneal samples from a large population of acute colic cases, NGAL was assessed specifically for its ability to differentiate between types of lesions causing colic 35 . Results showed that horses with nonstrangulating intestinal infarction caused by Strongylus vulgaris migration through the cranial mesenteric artery and inflammatory abdominal disease (enteritis, colitis, peritonitis) had significantly higher serum and peritoneal NGAL concentrations than the other horses with colic and healthy horses.…”

Highlights of recent clinically relevant papers

“…The aim of this retrospective clinical study by Malou Winther and co‐workers in Denmark was to investigate neutrophil gelatinase‐associated lipocalin (NGAL) in serum and peritoneal fluid in horses with abdominal disease .…”

Neutrophil gelatinase-associated lipocalin in dehydrated horses: A prospective case-control study

“…Based on the origin of NGAL, several studies which discussed its ability to differentiate in ammatory and non-in ammatory disease in equine patients were published [20][21][22]. However, NGAL's diagnostic value of renal diseases in equine medicine has not yet been widely…”

“…Serum and plasma NGAL appeared to increase 24-72 h earlier than creatinine in humans and indicated the acute renal damage in several studies [13][14][15][16]. Urinary NGAL also showed promising results and was elevated as early as 2 h after ischemic renal damage [17][18][19].Based on the origin of NGAL, several studies which discussed its ability to differentiate in ammatory and non-in ammatory disease in equine patients were published [20][21][22]. However, NGAL's diagnostic value of renal diseases in equine medicine has not yet been widely…”