Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy.
Intensive Care Med. 2010 Mar;36(3):444-51. doi: 10.1007/s00134-009-1711-1. Epub 2009 Dec 3.
Neutrophil gelatinase-associated lipocalin (NGAL) is a useful marker for acute kidney injury (AKI), particularly when the timing of renal insult is known. However, its performance in an adult critical care setting has not been well described. We performed this study to estimate the diagnostic accuracy of plasma NGAL for early detection of AKI and need for renal replacement therapy (RRT) in an adult intensive care unit (ICU).
We enrolled 307 consecutive adult patients admitted to a general medical-surgical ICU; 301 were included in the final analysis. Serial blood samples were analyzed for plasma NGAL using a standardized clinical platform. The primary outcome was AKI, defined as an increase in creatinine of at least 50% from baseline or a reduction in urine output to <0.5 ml/kg/h for >6 h.
Of 301 patients, 133 (44%) had AKI during their ICU stay. Plasma NGAL was a good diagnostic marker for AKI development within the next 48 h (area under ROC 0.78, 95% CI 0.65-0.90), and for RRT use (area under ROC 0.82, 95% CI 0.70-0.95). Peak plasma NGAL concentrations increased with worsening AKI severity (R = 0.554, P < 0.001).
Plasma NGAL is a useful early marker for AKI in a heterogeneous adult ICU population, in which the timing of renal insult is largely unknown. It allows the diagnosis of AKI up to 48 h prior to a clinical diagnosis based on AKI consensus definitions. Additionally, it predicts need for RRT and correlates with AKI severity. Early identification of high risk patients may allow potentially beneficial therapies to be initiated early in the disease process before irreversible injury occurs.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是急性肾损伤（AKI）的有用标志物，尤其是在已知肾损伤时间时。然而，它在成人重症监护环境中的性能尚未得到很好的描述。我们进行了这项研究，以评估血浆 NGAL 对 AKI 的早期检测和成人重症监护病房（ICU）中肾脏替代治疗（RRT）的需求的诊断准确性。
我们纳入了 307 例连续入住普通内科-外科 ICU 的成年患者；其中 301 例患者被纳入最终分析。使用标准化临床平台分析了用于血浆 NGAL 的连续血液样本。主要结局是 AKI，定义为基线时肌酐增加至少 50%或尿量减少至 <0.5 ml/kg/h 持续>6 h。
在 301 例患者中，有 133 例（44%）在 ICU 期间发生 AKI。NGAL 是预测未来 48 h 内 AKI 发展的良好诊断标志物（ROC 曲线下面积为 0.78，95%CI 0.65-0.90），也是预测 RRT 使用的良好标志物（ROC 曲线下面积为 0.82，95%CI 0.70-0.95）。峰值 NGAL 浓度随着 AKI 严重程度的恶化而增加（R = 0.554，P < 0.001）。
在肾损伤时间基本未知的成人 ICU 人群中，血浆 NGAL 是 AKI 的有用早期标志物。它可以在基于 AKI 共识定义的临床诊断之前提前 48 h 诊断 AKI。此外，它可以预测 RRT 的需求，并与 AKI 严重程度相关。早期识别高危患者可能使潜在有益的治疗能够在疾病过程的早期启动，从而在不可逆损伤发生之前。
