Delta index of the estimated glomerular filtration rate to amend the overestimated Neutrophil Gelatinase-Associated Lipocalin (NGAL) level in systemic inflammatory response syndrome

This study aimed to investigate a delta index of the estimated glomerular filtration rate (deGFR-index) to amend an overestimated neutrophil gelatinase-associated lipocalin (NGAL) level in systemic inflammatory response syndrome (SIRS). A delta eGFR-index was computed, and the NGAL/delta eGFR-index was determined. Patients with SIRS exhibited significantly higher levels in NGAL, the delta eGFR-index, and high sensitivity C-reactive protein (hsCRP) than non-SIRS inflammatory patients (216 ng/mL, 1.32, and 5.64 mg/dL vs. 153 ng/mL, 1.18, and 2.92 mg/dL, respectively, p < 0.05). After adjusting for potential confounders, the NGAL/deGFR-index was closely associated with serum hsCRP concentrations (standard beta = 0.552, p < 0.001). In a receiver operating characteristic curve, the diagnostic ability of the NGAL/delta eGFR-index to identify SIRS in inflammatory diseases was superior to that of the NGAL [0.712 (95% CI, 0.638-0.786) vs. 0.646 (95% CI, 0.567-0.726), p < 0.001]. The area under the curve of the NGAL/delta eGFR-index was significantly larger than that of NGAL for detecting hsCRP > 3.80 mg/dL in SIRS [0.761 (95% CI, 0.660-0.862) vs. 0.728 (95% CI, 0.625-0.831), p = 0.019]. In short, the NGAL/delta eGFR-index more correctly represents the disease activity in SIRS than the level of plasma NGAL. A measure of the NGAL/delta eGFRindex may be of additional help when monitoring patients with SIRS, particularly in conjunction with concurrent renal dysfunction. (C) 2017 Published by Elsevier Sp. z o. o. on behalf of Faculty of Health and Social Sciences, University of South Bohemia in Ceske Budejovice.