Gupta Babita, Tiwari Pallavi, Subramanian Arulselvi, Mahajan Sandeep, Kalaivani M, Bindra Ashish, Kumar Subodh, Gupta Amit, Aggrawal Richa, Soni Kapil Dev, Pandey R M
Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institute of Medical Sciences, New Delhi, India.
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institute of Medical Sciences, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2023 Apr-Jun;39(2):292-301. doi: 10.4103/joacp.joacp_284_21. Epub 2023 Feb 16.
Acute kidney injury (AKI) is a frequent complication of severe trauma associated with high mortality. The aim of this study was to evaluate the diagnostic ability of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of AKI assessed by RIFLE criteria as reference in trauma patients in intensive care unit (ICU).
This was a prospective observational study. Four hundred and eighteen patients admitted in the trauma ICU with age ≥18 years without known renal diseases were followed-up (serum creatinine, urine output, and estimated glomerular filtration rate) for 5 consecutive days. As per RIFLE criteria, 70 patients were broadly classified as AKI and rest of the patients (n = 348) as non-AKI. Plasma and urine samples of AKI (n = 70) and non-AKI (n = 70) patients were further assessed for 3 consecutive days following admission.
Mean plasma NGAL (pNGAL) was significantly elevated in AKI patients as compared with non-AKI patients; on admission: 204.08 versus 93.74 ng/mL ( = 0.01); at 24 h: 216.73 versus 94.63 ng/mL ( = 0.01); and 48 h: 212.77 versus 86.32 ng/mL ( = 0.01). Mean urine NGAL (uNGAL) at 48 h was also significantly elevated: 15.45 ng/mL in AKI patients as compared with 13.48 ng/mL in non-AKI patients ( = 0.01). Plasma and urine NGAL levels were significantly associated with increased mortality.
pNGAL had good predictive value on admission (area under the receiver operative characteristic [AUROC] 0.84), at 24 h (AUROC 0.88) and 48 h (AUROC 0.87), while uNGAL had moderate performance at 24 h (AUROC 0.61) and 48 h (AUROC 0.71). pNGAL can be used as an early and potent diagnostic and predictive marker of AKI and mortality in critically ill trauma patients.
急性肾损伤（AKI）是严重创伤常见的并发症，死亡率很高。本研究旨在评估血浆和尿液中性粒细胞明胶酶相关脂质运载蛋白（NGAL）作为AKI早期标志物的诊断能力，以RIFLE标准作为重症监护病房（ICU）创伤患者的参考标准。
这是一项前瞻性观察性研究。对418例入住创伤ICU、年龄≥18岁且无已知肾脏疾病的患者进行连续5天的随访（监测血清肌酐、尿量和估计肾小球滤过率）。根据RIFLE标准，70例患者大致分类为AKI，其余患者（n = 348）为非AKI。对AKI患者（n = 70）和非AKI患者（n = 70）的血浆和尿液样本在入院后连续3天进一步评估。
与非AKI患者相比，AKI患者的平均血浆NGAL（pNGAL）显著升高；入院时：204.08对93.74 ng/mL（P = 0.01）；24小时时：216.73对94.63 ng/mL（P = 0.01）；48小时时：212.77对86.32 ng/mL（P = 0.01）。48小时时的平均尿液NGAL（uNGAL）也显著升高：AKI患者为15.45 ng/mL，非AKI患者为13.48 ng/mL（P = 0.01）。血浆和尿液NGAL水平与死亡率增加显著相关。
pNGAL在入院时（受试者工作特征曲线下面积[AUROC]为0.84）、24小时时（AUROC为0.88）和48小时时（AUROC为0.87）具有良好的预测价值，而uNGAL在24小时时（AUROC为0.61）和48小时时（AUROC为0.71）表现中等。pNGAL可作为危重症创伤患者AKI和死亡率的早期有效诊断及预测标志物。
