The nature and discriminatory value of urinary neutrophil gelatinase-associated lipocalin in critically ill patients at risk of acute kidney injury
- 6 August 2013
- journal article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 39 (10), 1714-1724
- https://doi.org/10.1007/s00134-013-3040-7
Abstract
Different molecular forms of urinary neutrophil gelatinase-associated lipocalin (NGAL) have recently been discovered. We aimed to explore the nature, source and discriminatory value of urinary NGAL in intensive care unit (ICU) patients. We simultaneously measured plasma NGAL (pNGAL), urinary NGAL (uNGAL), and estimated monomeric and homodimeric uNGAL contribution using Western blotting-validated enzyme-linked immunosorbent assays [uNGALE1 and uNGALE2] and their calculated ratio in 102 patients with the systemic inflammatory response syndrome and oliguria, and/or a creatinine rise of >25 μmol/L. Bland–Altman analysis demonstrated that, despite correlating well (r = 0.988), uNGAL and uNGALE1 were clinically distinct, lacking both accuracy and precision (bias: 266.23; 95 % CI 82.03–450.44 ng/mg creatinine; limits of agreement: −1,573.86 to 2,106.32 ng/mg creatinine). At best, urinary forms of NGAL are fair (area under the receiver operating characteristic [AUROC] ≤0.799) predictors of renal or patient outcome; most perform significantly worse. The 44 patients with a primarily monomeric source of uNGAL had higher pNGAL (118.5 ng/ml vs. 72.5 ng/ml; p < 0.001), remaining significant following Bonferroni correction. uNGAL is not a useful predictor of outcome in this ICU population. uNGAL patterns may predict distinct clinical phenotypes. The nature and source of uNGAL are complex and challenge the utility of NGAL as a uniform biomarker.Keywords
This publication has 59 references indexed in Scilit:
- Systemic and Urinary Neutrophil Gelatinase-Associated Lipocalins Are Poor Predictors of Acute Kidney Injury in Unselected Critically Ill PatientsCritical Care Research and Practice, 2012
- Temporal Relationship and Predictive Value of Urinary Acute Kidney Injury Biomarkers After Pediatric Cardiopulmonary BypassJournal of the American College of Cardiology, 2011
- Neutrophil Gelatinase-associated Lipocalin at ICU Admission Predicts for Acute Kidney Injury in Adult PatientsAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: A prospective studyJournal of Critical Care, 2010
- Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU populationIntensive Care Medicine, 2009
- Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery—A prospective cohort study*Critical Care Medicine, 2009
- Urinary Biomarkers for Sensitive and Specific Detection of Acute Kidney Injury in HumansClinical and Translational Science, 2008
- Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008Intensive Care Medicine, 2007
- Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort studyCritical Care, 2007
- STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENTThe Lancet, 1986