Serum Neutrophil Gelatinase-associated Lipocalin Measured at Admission to Predict Mortality in Sepsis-associated Acute Kidney Injury of Vietnamese Critically Ill Patients

Abstract

Purpose: To evaluate incidence of sepsis-associated acute kidney injury (SA-AKI) in the AKI Intensive Care Unit (ICU) patients and predictive value of Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at the admission in mortality of SA-AKI and non SA-AKI. Patients and Methods: A study of 101 consecutive adult patients admitted to the Intensive Care Unit (ICU) diagnosed as AKI in which there were 60 patients with SA-AKI. Acute kidney injury was defined based on Acute Kidney Injury Network (AKIN) criteria. Serum NGAL was measured using the BioVendor Human Lipocalin-2/NGAL ELISA with blood sample taken at admission. Results: Incidence of septic acute kidney injury was 59.4%, incidence of death patients reached 20.0%. Mean concentration of serum NGAL in death group was 633.56 ng/ml, higher significantly than that of survival patients (328.84 ng/ml), p<0.005. Serum NGAL in non SA-AKI patients showed a better prognostic value to predict hospital mortality than that in SA-AKI patients (AUC: 0.894 and 0,807 respectively; p < 0.005) Conclusion: In SA-AKI patients, serum NGAL and mortality rate increased along with the stage of AKI. Serum NGAL, measuring at admission time, was a good prognostic biomarker of mortality in both SA-AKI and non SA-AKI patients.

Serum and Urine Neutrophil Gelatinase-Associated Lipocalin Levels Measured at Admission Predict Progression to Chronic Kidney Disease in Sepsis-Associated Acute Kidney Injury Patients

“…Infections, sepsis, shock, need for mechanical ventilation, and surgery are well recognized as high-risk factors for the development of AKI [ 28 ]. Sepsis has been reported to account for approximately 50% of patients with AKI in ICU, and it has been hypothesized that the modulation of proinflammatory cytokines in septic AKI might be beneficial [ 8 , 15 ]. Sepsis mediated hypoperfusion leading to tubular necrosis traditionally has been cited as the primary pathophysiology for SA-AKI; however, mounting evidence has challenged this paradigm [ 29 , 30 ].…”

“…The complications of AKI include increased susceptibility to infections, extrarenal organ damage, the development of CKD, and an increased rate of hospital readmission. NGAL, both in serum and urine, fulfills many of the characteristics important for a useful AKI biomarker and used in early diagnosis, which predicted mortality in not only all-cause AKI but also SA-AKI [ 11 – 15 ]. The results of this study can be simply understood that NGAL indirectly evaluates kidney damage, as NGAL increases mean severe kidney damage.…”

“…Recently, serum and urine neutrophil gelatinase-associated lipocalin (NGAL) levels were used as a biomarker to early diagnosis of AKI in both SA-AKI and non-SA-AKI patients [ 11 – 13 ]. Serum and urine NGAL levels were also used to predict mortality in SA-AKI patients [ 14 , 15 ].…”