Whole-blood neutrophil gelatinase-associated lipocalin to predict adverse events in acute kidney injury: A prospective observational cohort study

Rewa, Oleksa; Wald, Ron; Adhikari, Neill K. J.; Hladunewich, Michelle A.; Lapinsky, Stephen E.; Muscedere, John; Bagshaw, Sean M.; Smith, Orla M.; Lebovic, Gerald; Kuint, Rottem; Klein, David J.

doi:10.1016/j.jcrc.2015.08.019

Cited by 7 publications

(3 citation statements)

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“…Plasma, serum, and/or whole blood NGAL, analyzed in 22 studies [ 18 , 21 , 24 , 28 – 31 , 35 , 40 , 42 , 48 , 52 , 56 , 62 , 64 , 66 , 68 , 71 , 72 , 77 – 79 ] and 4391 patients, had a pooled AUC of 0.755 (0.706–0.803) (Fig. 4 ).…”

Section: Resultsmentioning

confidence: 99%

Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis

et al. 2018

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PurposeAcute kidney injury (AKI) frequently occurs in critically ill patients and often precipitates use of renal replacement therapy (RRT). However, the ideal circumstances for whether and when to start RRT remain unclear. We performed evidence synthesis of the available literature to evaluate the value of biomarkers to predict receipt of RRT for AKI.MethodsWe conducted a PRISMA-guided systematic review and meta-analysis including all trials evaluating biomarker performance for prediction of RRT in AKI. A systematic search was applied in MEDLINE, Embase, and CENTRAL databases from inception to September 2017. All studies reporting an area under the curve (AUC) for a biomarker to predict initiation of RRT were included.ResultsSixty-three studies comprising 15,928 critically ill patients (median per study 122.5 [31–1439]) met eligibility. Forty-one studies evaluating 13 different biomarkers were included. Of these biomarkers, neutrophil gelatinase-associated lipocalin (NGAL) had the largest body of evidence. The pooled AUCs for urine and blood NGAL were 0.720 (95% CI 0.638–0.803) and 0.755 (0.706–0.803), respectively. Blood creatinine and cystatin C had pooled AUCs of 0.764 (0.732–0.796) and 0.768 (0.729–0.807), respectively. For urine biomarkers, interleukin-18, cystatin C, and the product of tissue inhibitor of metalloproteinase-2 and insulin growth factor binding protein-7 showed pooled AUCs of 0.668 (0.606–0.729), 0.722 (0.575–0.868), and 0.857 (0.789–0.925), respectively.ConclusionThough several biomarkers showed promise and reasonable prediction of RRT use for critically ill patients with AKI, the strength of evidence currently precludes their routine use to guide decision-making on when to initiate RRT.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5126-8) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis

et al. 2018

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“…Several studies reported that an increased serum NGAL level is useful in predicting nephrology consultation, dialysis, and ICU admission 13 , 21 , 22 . However, the study by Rewa et al 23 did not show the significance of serum NGAL level for predicting 30‐day mortality rates and the rates of dialysis in the ICU. Our study also did not confirm that serum NGAL level is useful for predicting 30‐day mortality rates or need for dialysis.…”

Section: Discussionmentioning

confidence: 98%

Utility of neutrophil gelatinase-associated lipocalin in the management of acute kidney injury: A prospective, observational study

Işıkkent

Yılmaz

Özturan

et al. 2018

Hong Kong Journal of Emergency Medicine

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Background: Utilization of renal biomarkers such as neutrophil gelatinase-associated lipocalin in the management of acute kidney injury may be useful as a diagnostic tool in the emergency department. Objective: The aim of this study is to determine the relationship between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification, and to investigate the role of the serum neutrophil gelatinase-associated lipocalin level in differentiating the etiology and predicting the 30-day mortality rate and need for dialysis. Methods: This prospective, observational study was conducted from March 2015 to 2016. Adult patients with acute kidney injury in the emergency department were enrolled in the study. Demographic and clinical features such as hypovolemic state, nephrotoxic substance exposure, renal functions, and serum neutrophil gelatinase-associated lipocalin level were evaluated. After the etiology of the acute kidney injury was ascertained, the severity of the acute kidney injury was determined according to RIFLE criteria. Primary outcome was defined as the correlation between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury according to RIFLE classification. Secondary outcomes were defined as the relationship between the serum neutrophil gelatinase-associated lipocalin level and the etiology of the acute kidney injury; need for dialysis and 30-day mortality were defined as poor outcomes. Results: A total of 87 patients were included in the study. Mean serum neutrophil gelatinase-associated lipocalin levels were 380.14 ± 276.65 ng/mL in RIFLE-R, 425.80 ± 278.99 ng/mL in RIFLE-I, and 403.60 ± 293.15 ng/mL in RIFLE-F groups. There was no statistically significant relationship between the severity of acute kidney injuries and serum neutrophil gelatinase-associated lipocalin level. Initial serum neutrophil gelatinase-associated lipocalin levels in the emergency department did not indicate a statistically significant ability to predict the etiology of acute kidney injury, 30-day mortality rates, or need for dialysis. Conclusion: Initial serum neutrophil gelatinase-associated lipocalin level in the emergency department is not a determinant tool for predicting the severity, etiology, 30-day mortality rates, or need for dialysis in cases of acute kidney injuries.

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“…The relationship observed in this study between HNL and severe AKI, with an assay aimed at neutrophil-specific dimeric HNL, suggests that neutrophils play a part in the phenomenon of lung–kidney crosstalk in critical care, where the failing of one of the two is often associated with the failing of the other, as has been proposed previously [ 42 , 43 ]. Earlier studies have investigated the use of whole blood and plasma NGAL as biomarkers of AKI development in intensive care, often without discriminating between the different isoforms of the biomarker [ 44 , 45 ]. In the present study, dimeric HNL in plasma early on during intensive care was associated with AKI and CRRT, suggesting that this particular molecular form may have potential as a biomarker of severe AKI.…”

Section: Discussionmentioning

confidence: 99%

Systemic Human Neutrophil Lipocalin Associates with Severe Acute Kidney Injury in SARS-CoV-2 Pneumonia

Anderberg

Lipcsey

Hultström

et al. 2021

JCM

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Neutrophils have been suggested mediators of organ dysfunction in COVID-19. The current study investigated if systemic neutrophil activity, estimated by human neutrophil lipocalin (HNL) concentration in peripheral blood, is associated with acute kidney injury (AKI) development. A total of 103 adult patients admitted to intensive care, with PCR-confirmed SARS -CoV-2 infection, were prospectively included (Clinical Trials ID: NCT04316884). HNL was analyzed in plasma (P-HNL Dimer) and in whole blood (B-HNL). The latter after ex vivo activation with N-formyl-methionine-leucine-phenylalanine. All patients developed respiratory dysfunction and 62 (60%) were treated with invasive ventilation. Sixty-seven patients (65%) developed AKI, 18 (17%) progressed to AKI stage 3, and 14 (14%) were treated with continuous renal replacement therapy (CRRT). P-HNL Dimer was higher in patients with invasive ventilation, vasopressors, AKI, AKI stage 3, dialysis, and 30-day mortality (p < 0.001–0.046). B-HNL performed similarly with the exception of mild AKI and mortality (p < 0.001–0.004). The cohort was dichotomized by ROC estimated cutoff concentrations of 13.2 µg/L and 190 µg/L for P-HNL Dimer and B-HNL respectively. Increased cumulative risks for AKI, AKI stage 3, and death were observed if above the P-HNL cutoff and for AKI stage 3 if above the B-HNL cutoff. The relative risk of developing AKI stage 3 was nine and 39 times greater if above the cutoffs in plasma and whole blood, respectively, for CRRT eight times greater for both. In conclusion, systemically elevated neutrophil lipocalin, interpreted as increased neutrophil activity, was shown to be associated with an increased risk of severe AKI, renal replacement therapy, and mortality in COVID-19 patients with respiratory failure.

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Whole-blood neutrophil gelatinase-associated lipocalin to predict adverse events in acute kidney injury: A prospective observational cohort study

Cited by 7 publications

References 38 publications

Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis

Biomarkers for prediction of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis

Utility of neutrophil gelatinase-associated lipocalin in the management of acute kidney injury: A prospective, observational study

Systemic Human Neutrophil Lipocalin Associates with Severe Acute Kidney Injury in SARS-CoV-2 Pneumonia

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