Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Applied Drug Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
J Clin Anesth. 2018 Feb;44:12-17. doi: 10.1016/j.jclinane.2017.10.010.
To examine urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL) levels in predicting ICU mortality.
Prospective observational.
University Critical Care setting.
50 patients with acute kidney injury (AKI).
None.
Serial urinary and plasma concentrations of NGAL were measured. Twenty-five patients had early progression (EP) and 25 patients had early improvement (EI) of AKI. Plasma concentrations of NGAL in the EP group (N=25) were significantly higher than those in the EI group (129 [IQR; 20] vs. 111 [IQR; 32] ng/mL; P=0.009), while urine NGAL levels on admission were similar in both groups (61 [IQR; 20] vs. 65 [IQR; 20] ng/mL; P=0.767). Plasma NGAL concentrations rapidly decreased to 87 [32] ng/mL in the EI group (P<0.001) and while it remained elevated in the EP group (138 [21] ng/mL). Within 28-days, 50% of the patients died in the EP group, whereas no patient died in the EI group (P<0.001). Plasma NGAL was a fair predictor for progression of AKI (AUC; 0.719±0.063; P=0.006). 48-hour changes in plasma NGAL levels predicted death within 28-days of ICU admission (AUC; 0.874±0.048; P<0.001).
Early progression of AKI was associated with more death within 28 and 90days. While one time measurement of plasma NGAL levels at the time ICU admission may represent the kidney health status in critical care settings, it does not reliably predict mortality. On the other hand, changes in plasma NGAL within 48h of admission improve the value of this biomarker in predicting ICU mortality.
检测尿和血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平在预测 ICU 死亡率中的作用。
前瞻性观察。
大学重症监护病房。
50 例急性肾损伤（AKI）患者。
无。
连续测量尿和血浆 NGAL 浓度。25 例患者出现早期进展（EP），25 例患者出现 AKI 的早期改善（EI）。EP 组（n=25）的血浆 NGAL 浓度明显高于 EI 组（129[IQR；20] vs. 111[IQR；32]ng/mL；P=0.009），而两组入院时尿 NGAL 水平相似（61[IQR；20] vs. 65[IQR；20]ng/mL；P=0.767）。EI 组血浆 NGAL 浓度迅速降至 87[32]ng/mL（P<0.001），而 EP 组仍升高（138[21]ng/mL）。在 28 天内，EP 组有 50%的患者死亡，而 EI 组无患者死亡（P<0.001）。血浆 NGAL 对 AKI 进展的预测能力为中等（AUC；0.719±0.063；P=0.006）。入院后 48 小时内血浆 NGAL 水平的变化预测 ICU 入院后 28 天内的死亡（AUC；0.874±0.048；P<0.001）。
AKI 的早期进展与 28 天和 90 天内的死亡率增加有关。虽然 ICU 入院时单次测量血浆 NGAL 水平可以代表重症监护环境中的肾脏健康状况，但它不能可靠地预测死亡率。另一方面，入院后 48 小时内血浆 NGAL 水平的变化提高了该生物标志物预测 ICU 死亡率的价值。
