Urine Neutrophil Gelatinase-Associated Lipocalin Moderately ... : Journal of the American Society of Nephrology (original) (raw)

CLINICAL RESEARCH

Urine Neutrophil Gelatinase-Associated Lipocalin Moderately Predicts Acute Kidney Injury in Critically Ill Adults

Siew, Edward D.*; Ware, Lorraine B.†; Gebretsadik, Tebeb‡; Shintani, Ayumi‡; Moons, Karel G. M.§; Wickersham, Nancy†; Bossert, Frederick†; Ikizler, T. Alp*

*Vanderbilt University Medical Center, Department of Medicine, Division of Nephrology, Nashville, Tennessee;

†Vanderbilt University Medical Center, Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Nashville, Tennessee;

‡Vanderbilt University Medical Center, Department of Biostatistics, Nashville, Tennessee;

§Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

Correspondence: Dr. T. Alp Ikizler, Vanderbilt University Medical Center, 1161 21st Avenue South/MCN S-3312, Nashville, TN 37232. Phone: 615-343-6104; Fax: 615-343-7156; E-mail: [email protected]

Received July 2, 2008

Accepted April 1, 2009

Abstract

Urine neutrophil gelatinase-associated lipocalin (uNGAL) has shown promise as a biomarker for the early detection of acute kidney injury (AKI) in fixed models of injury, but its ability to predict AKI and provide prognostic information in critically ill adults is unknown. We prospectively studied a heterogeneous population of 451 critically ill adults, 64 (14%) and 86 (19%) of whom developed AKI within 24 and 48 h of enrollment, respectively. Median uNGAL at enrollment was higher among patients who developed AKI within 48 h compared with those who did not (190 versus 57 ng/mg creatinine, P < 0.001). The areas under the receiver operating characteristic curves describing the relationship between uNGAL level and the occurrence of AKI within 24 and 48 h were 0.71 (95% Confidence Intervals [CI]: 0.63 to 0.78) and 0.64 (95% CI: 0.57 to 0.71), respectively. Urine neutrophil gelatinase-associated lipocalin remained independently associated with the development of AKI after adjustment for age, serum creatinine closest to enrollment, illness severity, sepsis, and intensive care unit (ICU) location, although it only marginally improved the predictive performance of the clinical model alone. A Cox proportional hazards model using time to first dialysis, adjusted for APACHE II score, suggested that uNGAL independently predicts severe AKI during hospitalization [HR 2.60, 95% CI:1.55 to 4.35]. In summary, although a single measurement of uNGAL exhibited moderate predictive utility for the development and severity of AKI in a heterogeneous ICU population, its additional contribution to conventional clinical risk predictors appears limited.