Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness

Purpose Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI). We evaluated the diagnostic and prognostic accuracies of plasma NGAL (pNGAL) for contrast-induced AKI (CI-AKI) in critically ill patients. Methods In a prospective observational study in...

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Bibliographic Details
Published in:Intensive care medicine 2013-05, Vol.39 (5), p.857-865
Main Authors: Valette, Xavier, Savary, Benoit, Nowoczyn, Marie, Daubin, Cédric, Pottier, Véronique, Terzi, Nicolas, Seguin, Amélie, Fradin, Sabine, Charbonneau, Pierre, Hanouz, Jean-Luc, du Cheyron, Damien
Format: Article
Language:English
Subjects:
Accuracy
Acute Kidney Injury - blood
Acute Kidney Injury - chemically induced
Acute Kidney Injury - mortality
Aged
Anesthesiology
Angiography
Area Under Curve
Biomarkers
Biomarkers - blood
Blood
Contrast Media - adverse effects
Creatinine
Creatinine - blood
Critical Care Medicine
Critical Illness
Emergency Medicine
Ethylenediaminetetraacetic acid
Female
France
Gelatinases - blood
Health aspects
Health Status Indicators
Heart surgery
Humans
Intensive
Intensive care
Intensive Care Units
Kidneys
Lipocalins - blood
Logistic Models
Male
Medical examination
Medical imaging
Medicine
Medicine & Public Health
Middle Aged
Mortality
Neutrophils
Neutrophils - metabolism
Original
Pain Medicine
Pediatrics
Plasma
Pneumology/Respiratory System
Prospective Studies
Renal Replacement Therapy
ROC Curve
Sensitivity and Specificity
Sepsis
Sepsis - blood
Sepsis - mortality
Tomography, X-Ray Computed
United Kingdom
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Summary:Purpose Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI). We evaluated the diagnostic and prognostic accuracies of plasma NGAL (pNGAL) for contrast-induced AKI (CI-AKI) in critically ill patients. Methods In a prospective observational study in two adult intensive care units in a university hospital, 100 consecutive critically ill patients with stable serum creatinine concentrations up to 48 h before contrast medium (CM) injection were enrolled. Serial blood sampling for pNGAL analysis was performed at enrolment, 2, 6, and 24 h after CM injection. The primary outcome was CI-AKI, defined by AKIN criteria, within the first 72 h following CM injection. Secondary outcomes were the need for renal replacement therapy (RRT) and mortality. Results Of the 98 patients analyzed, 30 developed CI-AKI. The pNGAL levels did not differ in patients with or without CI-AKI, and were higher in septic patients compared to nonseptic patients, and in patients with AKI preceding CM injection. The discriminative value of pNGAL to predict CI-AKI and mortality was poor; although, it did predict the need for RRT requirement after CM injection (area under receiver-operating characteristic curve, 0.85, 0.80, 0.83 and 0.86 at H0, H2, H6 and H24, respectively). Conclusion CI-AKI was common in critically ill patients. pNGAL levels were higher in patients with sepsis or previous AKI, but did not help to diagnose CI-AKI any earlier than serum creatinine after CM injection. However, pNGAL could be of interest to detect patients at risk of subsequent RRT requirement.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-013-2826-y