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

Abstract

Omminea Alsaied (2) Ibraheim Rageh (3) Departments of Anesthesia & ICU (1) , Medical Biochemistry (2) & Clinical Pathology (3) , 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.