Neutrophil Gelatinase-Associated Lipocalin for Predicting Intensive Care Unit Admission and Mortality in Patients with Pneumonia

Abstract

Pneumonia is one of the most common causes of hospital admissions and mortality, and it is responsible for significant socioeconomic burden worldwide. Neutrophil gelatinase-associated lipocalin (NGAL) is a 25-kDa protein, which is involved in iron trafficking and has chemostatic and bacteriostatic effects. NGAL is also known as an early marker of many inflammatory diseases. However, little is known about the role of NGAL in the management of pneumonia. Thus, this study aimed to investigate whether plasma NGAL levels can predict intensive care unit (ICU) admission and in-hospital mortality in patients with pneumonia. This retrospective observational study included 241 adults hospitalized with pneumonia who underwent NGAL measurement. We compared the prognostic values of plasma NGAL with pneumonia severity index (PSI) for prediction of ICU admission and in-hospital mortality. Of 241 patients, 47 (19.5%) died during hospital admission. There was no significant difference between NGAL and PSI for predicting ICU admission (area under the receiver operating characteristic curve [AUC] of log NGAL vs. PSI, P > 0.999). Although log NGAL was useful in predicting in-hospital mortality, its ability was inferior to that of PSI (AUC of log NGAL vs. PSI, P = 0.008). Multivariable analysis revealed that log NGAL was significantly associated with ICU admission (adjusted odds ratio = 10.76, P < 0.001) and in-hospital mortality (adjusted odds ratio = 5.04, P = 0.004). These results suggest that plasma NGAL level is a useful biomarker for predicting ICU admission and mortality in hospitalized patients with pneumonia.

Lipocalin-2 promotes acute lung inflammation and oxidative stress by enhancing macrophage iron accumulation

“…For example, LCN2 limits iron uptake in the host, which reduces bacterial growth during the innate immune response [10][11][12]. In experimental models of pneumonia or sepsis, LCN2 deficiency increases bacterial proliferation and lowers host survival [13][14][15][16][17]. In contrast, LCN2 deletion has been shown to markedly attenuate the production of proinflammatory cytokines in mice with ARDS [18].…”

Impact of Neutrophil Gelatinase-associated Lipocalin A Novel Sepsis Biomarker on PRISM III Score in Predicting Sepsis Severity And Mortality in Pediatric Intensive Care Units (Single Center Study)

“…Pneumonia contracted from the community, gastroenteritis, and meningitis were the most frequently identi ed infections necessitating PICU hospitalization. [34] In the study of Min et al, 2020, 241 hospitalized patients with pneumonia, examined the relationship between plasma levels of NGAL, admission to the intensive care unit, and in-hospital death. Patients who were hospitalized to the ICU had NGAL levels that were noticeably greater than the ones who were discharged.…”

“…Similar to this, patients who did not survive had a higher likelihood of having higher NGAL levels than those who did. [35][36][37] Previous reports for patients with bacterial meningitis, high levels of NGAL in their CSF were found. [38,39] Additionally, NGAL is a highly sensitive and reliable marker for differentiating bacterial meningitis from a variety of other CNS Page 6/16…”

Evaluation of Plasma Lipocalin-2 as a Predictor of Etiology and Severity in Adult Patients with Community-Acquired Pneumonia

“…LCN2 exists as a monomer or heterodimer, which is produced by both neutrophils and epithelial cells, and in dimeric form that is exclusively released by neutrophils [ 4 , 29 ]. It has traditionally been used as a marker of acute kidney failure [ 30 ], but it has been also proposed as a biomarker of infection [ 12 ], including respiratory tract infections (RTI) [ 7 , 19 , 20 , 21 , 22 , 23 ].…”

“…Several studies found that plasma LCN2 concentration is a valuable biological marker in the assessment of the severity and prediction of the prognosis of patients with CAP [ 7 , 19 , 20 , 21 , 22 , 23 , 24 ].…”