Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: A prospective study

被引:106
作者
Constantin, Jean-Michel [1 ]
Futier, Emmanuel
Perbet, Sebastien
Roszyk, Laurence [2 ]
Lautrette, Alexandre [3 ]
Gillart, Thierry [4 ]
Guerin, Renaud
Jabaudon, Matthieu
Souweine, Bertrand [3 ]
Bazin, Jean-Etienne
Sapin, Vincent [2 ]
机构
[1] Univ Hosp Clermont Ferrand, Hotel Dieu Hosp, CHU Clermont Ferrand,Dept Anesthesiol & Crit Care, Serv Reanimat Adulte,Surg Intens Care Unit, F-63058 Clermont Ferrand, France
[2] Univ Hosp Clermont Ferrand, Dept Biochem & Mol Biol, F-63058 Clermont Ferrand, France
[3] Univ Hosp Clermont Ferrand, Gabriel Montpied Hosp, Med Intens Care Unit, F-63058 Clermont Ferrand, France
[4] Univ Hosp Clermont Ferrand, Gabriel Montpied Hosp, Surg Intens Care Unit, F-63058 Clermont Ferrand, France
关键词
Acute kidney injury; Critical care medicine; Adult; NGAL; Biomarker; ACUTE-RENAL-FAILURE; NGAL; BIOMARKER; THERAPY; CHILDREN;
D O I
10.1016/j.jcrc.2009.05.010
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: The aim of the study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict acute kidney injury (AKI) in adult intensive care unit (ICU) patients. Methods: All consecutives patients admitted to 3 ICUs were enrolled in this prospective-observational study. Plasma neutrophil gelatinase-associated lipocalin was analyzed at ICU admission. Risk, injury, failure, loss, and end-stage kidney (RIFLE) criteria were calculated at admission and for each day during the first week. Patients were classified according to whether they met the threshold for RIFLE criteria (RIFLE 0 or 1) at admission and during the first week. Four groups were identified: RIFLE (0-0), (1-1), (1-0), and (0-1). Results: During this 1-month period, 88 patients were included in the study. Thirty-six patients met the criteria for RIFLE 0-0 with a mean pNGAL of 98 +/- 60 nmol/L, 22 for RIFLE 1-1 with a mean pNGAL of 516 +/- 221 nmol/L, and 20 patients had no AKI at admission but develop AKI at 48 hours (24-96 hours) (RIFLE 0-1) with a pNGAL of 342 +/- 183 nmol/L. Ten patients met the criteria for RIFLE 1-0 and had a mean pNGAL of 169 +/- 100 nmol/L. Using a cutoff of 155 nmol/L, sensitivity and specificity to predict AKI were 82% and 97%, respectively (area under the curve [AUC] = 0.92 [0.852-0.972]; P = .001). Looking at the patients without AKI at admission (n = 56) and who developed (n = 20) or did not develop (n = 36) AKI, receiver operating characteristic curve analysis was as follows: AUC = 0.956 (0.864-0.992). Sensitivity was 85% and specificity was 97%. Of the 7 patients who required renal replacement therapy, all of them had pNGAL of more than 303 nmol/L (AUC = 0.788 [0.687-0.868]). Conclusion: Plasma neutrophil gelatinase-associated lipocalin at ICU admission is an early biomarker of AKI in adult ICU patients. Plasma neutrophil gelatinase-associated lipocalin increased 48 hours before RIFLE criteria. (C) 2010 Elsevier Inc. All rights reserved.
引用
收藏
页码:176.e1 / 176.e6
页数:6
相关论文
共 22 条
[1]   Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury [J].
Bagshaw, Sean M. ;
Uchino, Shigehiko ;
Bellomo, Rinaldo ;
Morimatsu, Hiroshi ;
Morgera, Stanislao ;
Schetz, Miet ;
Tan, Ian ;
Bouman, Catherine ;
Macedo, Ettiene ;
Gibney, Noel ;
Tolwani, Ashita ;
Oudemans-van Straaten, Heleen M. ;
Ronco, Claudio ;
Kellum, John A. .
JOURNAL OF CRITICAL CARE, 2009, 24 (01) :129-140
[2]   Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group [J].
Bellomo, R ;
Ronco, C ;
Kellum, JA ;
Mehta, RL ;
Palevsky, P .
CRITICAL CARE, 2004, 8 (04) :R204-R212
[3]   Urinary neutrophil gelatinase-associated lipocalin as a biomarker of nephritis in childhood-onset systemic lupus erythematosus [J].
Brunner, Hermine I. ;
Mueller, Michelle ;
Rutherford, Cynthia ;
Passo, Murray H. ;
Witte, David ;
Grom, Alexei ;
Mishra, Java ;
Devarajan, Prasad .
ARTHRITIS AND RHEUMATISM, 2006, 54 (08) :2577-2584
[4]   Urine Neutrophil Gelatinase-Associated Lipocalin and Interleukin-18 Predict Acute Kidney Injury after Cardiac Surgery [J].
Chen Xin ;
Xiao Yulong ;
Chen Yu ;
Cao Changchun ;
Zhou Feng ;
Mu Xinwei .
RENAL FAILURE, 2008, 30 (09) :904-913
[5]   Acute kidney injury, mortality, length of stay, and costs in hospitalized patients [J].
Chertow, GM ;
Burdick, E ;
Honour, M ;
Bonventre, JV ;
Bates, DW .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2005, 16 (11) :3365-3370
[6]   INTERVENTIONS IN CLINICAL ACUTE-RENAL-FAILURE - WHAT ARE THE DATA [J].
CONGER, JD .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1995, 26 (04) :565-576
[7]   Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery: a prospective uncontrolled cohort study [J].
Dent, Catherine L. ;
Ma, Qing ;
Dastrala, Sudha ;
Bennett, Michael ;
Mitsnefes, Mark M. ;
Barasch, Jonathan ;
Devarajan, Prasad .
CRITICAL CARE, 2007, 11 (06)
[8]  
Devarajan P, 2007, CONTRIB NEPHROL, V156, P203
[9]   K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification - Foreword [J].
Eknoyan, G ;
Levin, NW .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2002, 39 (02) :S14-S266
[10]   Initial versus delayed acute renal failure in the intensive cave unit - A multicenter prospective epidemiological study [J].
Guerin, C ;
Girard, R ;
Selli, JM ;
Perdrix, JP ;
Ayzac, L .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 161 (03) :872-879