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Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness

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Abstract

Objective

Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI.

Design

Prospective observational study.

Setting

Two adult ICUs in Melbourne, Australia.

Patients

Critically ill patients with septic and non-septic AKI.

Interventions

None.

Measurements and main results

Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82).

Conclusion

Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.

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Acknowledgments

Dr. Bagshaw is supported by a Clinical Investigator Award from the Alberta Heritage Foundation for Medical Research. Dr Haase holds a postdoctoral Feodor-Lynen Research Fellowship from the Alexander von Humboldt Foundation, Germany. This study was funding by a grant from the Austin Anaesthesia and Intensive Care Trust. We would like to thank Dr. Peter Ward from the Austin Hospital and Kevin Keegan from BioSite Inc. (subsidiary of Inverness Medical Innovations).

Conflicts of interest statement

Drs. Bellomo and Devarajan have acted as paid consultants for Abbott Diagnostics and Inverness Medical. Dr. Haase has received an honorarium for speaking for Abbott Diagnostics and Biosite Incorporated. Dr. Bagshaw has received an honorarium for speaking for Inverness Medical. Both companies are involved in the development of NGAL assays to be applied in clinical practice.

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Correspondence to Sean M. Bagshaw.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-009-1733-8.

This comment refers to the articles available at: doi:10.1007/s00134-009-1711-1 and 10.1007/s00134-009-1726-7.

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Bagshaw, S.M., Bennett, M., Haase, M. et al. Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med 36, 452–461 (2010). https://doi.org/10.1007/s00134-009-1724-9

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