Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, 3C1.16 Walter C Mackenzie Centre, 8440-122 Street, Edmonton, AB T6G2B7, Canada.
Intensive Care Med. 2010 Mar;36(3):452-61. doi: 10.1007/s00134-009-1724-9. Epub 2009 Dec 3.
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.
Prospective observational study.
Two adult ICUs in Melbourne, Australia.
Critically ill patients with septic and non-septic AKI.
None.
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).
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.
脓毒症是危重症患者急性肾损伤（AKI）最常见的诱因。本研究旨在确定脓毒症与非脓毒症 AKI 相比，其血浆和尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是否存在独特的模式。
前瞻性观察性研究。
澳大利亚墨尔本的 2 个成人 ICU。
脓毒症和非脓毒症 AKI 的危重症患者。
无。
在纳入时、12 小时、24 小时和 48 小时采集血液和尿液标本，以测量血浆和尿液 NGAL。共纳入 83 例患者（脓毒症组 43 例）。脓毒症 AKI 患者合并更多的疾病（p = 0.005）、急诊手术入院（p < 0.001）、更高的疾病严重程度（p = 0.008）、更多的器官功能障碍（p = 0.008）和更高的白细胞计数（p = 0.01）。两组在 AKI 严重程度上无差异。与非脓毒症 AKI 相比，脓毒症 AKI 患者在纳入时的血浆（293 与 166ng/ml）和尿液（204 与 39ng/mg 肌酐）NGAL 显著升高（p < 0.001）。与非脓毒症 AKI 相比，脓毒症 AKI 在 12 小时（p < 0.001）和 24 小时（p < 0.001）时尿液 NGAL 仍更高。血浆 NGAL 对 AKI 进展的区分度较好（ROC 曲线下面积 0.71），对肾脏替代治疗的区分度较好（AuROC 0.78）。尽管尿液 NGAL 的性能稍差（AuROC 0.70，0.70），但非脓毒症 AKI 患者中峰值尿液 NGAL 对 AKI 进展的预测更好（AuROC 0.82）。
与非脓毒症 AKI 患者相比，脓毒症 AKI 患者具有更高的可检测血浆和尿液 NGAL。脓毒症 AKI 中 NGAL 值的这些差异可能具有诊断和临床意义以及发病机制意义。
