Department of Nephrology & Hypertension, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625, Hannover, Germany.
Crit Care. 2010;14(1):R9. doi: 10.1186/cc8861. Epub 2010 Feb 1.
Neutrophil gelatinase-associated lipocalin (NGAL) is a promising novel biomarker that correlates with the severity and outcome of acute kidney injury (AKI). However, its prognostic utility during the late course of AKI, especially in patients that require renal replacement therapy (RRT) remains unknown. The aim of this study was to evaluate the predictive value of serum NGAL in patients with established AKI at inception of RRT in the intensive care unit (ICU).
Serum NGAL (ELISA methodology) was measured in 109 critically ill patients with AKI at inception of RRT in 7 ICUs of a tertiary care university hospital. The primary outcome studied was 28-day mortality. Secondary outcome measures were ICU length of stay, ventilator-free days, and renal recovery at day 28.
There was a significant difference in serum NGAL between healthy subjects (median [interquartile range] 39.0 [37.5-42.75] ng/mL), critically ill patients with systemic inflammatory response syndrome (SIRS) (297 [184-490] ng/mL), and critically ill patients with sepsis (708 [365-1301] ng/mL; P < 0.0001), respectively. Multiple linear regression showed that NGAL levels were independently related to the severity of AKI and the extent of systemic inflammation. NGAL levels were higher in non-survivors (430 [303-942] ng/mL) compared to survivors (298 [159-506] ng/mL; P = 0.004). Consistently, Cox proportional hazards regression analysis identified NGAL as a strong independent predictor for 28-day survival (hazard ratio 1.6 (95% confidence interval [CI] 1.15 - 2.23), P = 0.005).
This is the first prospective evaluation of serum NGAL as an outcome-specific biomarker in critically ill patients at initiation of RRT. The results from this study indicate that serum NGAL is as an independent predictor of 28-day mortality in ICU patients with dialysis-dependent AKI.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是一种有前途的新型生物标志物，与急性肾损伤（AKI）的严重程度和结果相关。然而，其在 AKI 后期的预后实用性，特别是在需要肾脏替代治疗（RRT）的患者中，尚不清楚。本研究旨在评估血清 NGAL 在重症监护病房（ICU）开始 RRT 时确诊 AKI 患者中的预测价值。
在一家三级教学医院的 7 个 ICU 中，对 109 例开始 RRT 的 AKI 重症患者进行血清 NGAL（酶联免疫吸附试验法）检测。主要研究终点为 28 天死亡率。次要终点为 ICU 住院时间、无呼吸机天数和第 28 天的肾功能恢复。
健康受试者（中位数[四分位距]39.0[37.5-42.75]ng/mL）、全身炎症反应综合征（SIRS）的危重病患者（297[184-490]ng/mL）和脓毒症的危重病患者（708[365-1301]ng/mL）之间的血清 NGAL 存在显著差异（P<0.0001）。多元线性回归显示，NGAL 水平与 AKI 的严重程度和全身炎症的程度独立相关。与存活者（298[159-506]ng/mL）相比，死亡患者的 NGAL 水平更高（430[303-942]ng/mL；P=0.004）。同样，Cox 比例风险回归分析表明，NGAL 是 28 天生存的一个强有力的独立预测因子（风险比 1.6[95%置信区间[CI]1.15-2.23]，P=0.005）。
这是首次前瞻性评估血清 NGAL 在开始 RRT 时作为危重病患者特定结局的生物标志物。本研究结果表明，血清 NGAL 是 ICU 中依赖透析的 AKI 患者 28 天死亡率的独立预测因子。
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