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

Intensive Care Med. 2013 May;39(5):857-65. doi: 10.1007/s00134-013-2826-y. Epub 2013 Jan 30.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / chemically induced*
  • Acute Kidney Injury / mortality
  • Aged
  • Angiography
  • Area Under Curve
  • Biomarkers / blood
  • Contrast Media / adverse effects*
  • Creatinine / blood
  • Critical Illness*
  • Female
  • Gelatinases / blood*
  • Health Status Indicators
  • Humans
  • Intensive Care Units
  • Lipocalins / blood*
  • Logistic Models
  • Male
  • Middle Aged
  • Neutrophils / metabolism
  • Prospective Studies
  • ROC Curve
  • Renal Replacement Therapy
  • Sensitivity and Specificity
  • Sepsis / blood
  • Sepsis / mortality
  • Tomography, X-Ray Computed

Substances

  • Biomarkers
  • Contrast Media
  • Lipocalins
  • Creatinine
  • Gelatinases