Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis

P B Hjortrup; N Haase; F Treschow; M H Møller; A Perner

doi:10.1111/aas.12427

Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis

P B Hjortrup, N Haase, F Treschow, M H Møller, A Perner

Department of Clinical Medicine

23 Citations (Scopus)

Abstract

Background: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis.

Methods: This was a prospective observational study in three general intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU, development of AKI according to the Kidney Disease: Improving Global Outcomes plasma creatinine criteria within 48 h and 90-day mortality.

Results: Two-hundred- twenty-two patients had samples taken (211 had plasma and 162 urine sampled); simplified acute physiology score II was 54 (39-66). Forty patients (18%) had RRT in the ICU, 91 patients had AKI at enrolment; of the remaining 131 patients 24% developed AKI during the first 48 h, and 55% had died at 90 days. Areas under receiver-operating characteristics curve (AuROC) for predicting use of RRT in ICU were 0.70 (95% confidence interval 0.61-0.78) and 0.62 (0.51-0.73) for plasma and urine NGAL, respectively. AuROC of plasma and urine NGAL for AKI were 0.66 (0.54-0.77) and 0.71 (0.59-0.82), respectively, and for 90-day mortality 0.55 (0.47-0.63) and 0.61 (0.53-0.70), respectively. Combining NGAL values with plasma creatinine did not improve AuROCs.

Conclusion: In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	59
Issue number	1
Pages (from-to)	25-34
Number of pages	10
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.12427
Publication status	Published - 1 Jan 2015

Keywords

Acute Kidney Injury
Acute-Phase Proteins
Adult
Aged
Creatinine
Female
Humans
Lipocalins
Male
Middle Aged
Outcome Assessment (Health Care)
Predictive Value of Tests
Prospective Studies
Proto-Oncogene Proteins
ROC Curve
Renal Replacement Therapy
Sepsis

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@article{823e03483a6243adb1af2233d4d3a8a7,

title = "Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis",

abstract = "Background: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis.Methods: This was a prospective observational study in three general intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU, development of AKI according to the Kidney Disease: Improving Global Outcomes plasma creatinine criteria within 48 h and 90-day mortality.Results: Two-hundred- twenty-two patients had samples taken (211 had plasma and 162 urine sampled); simplified acute physiology score II was 54 (39-66). Forty patients (18%) had RRT in the ICU, 91 patients had AKI at enrolment; of the remaining 131 patients 24% developed AKI during the first 48 h, and 55% had died at 90 days. Areas under receiver-operating characteristics curve (AuROC) for predicting use of RRT in ICU were 0.70 (95% confidence interval 0.61-0.78) and 0.62 (0.51-0.73) for plasma and urine NGAL, respectively. AuROC of plasma and urine NGAL for AKI were 0.66 (0.54-0.77) and 0.71 (0.59-0.82), respectively, and for 90-day mortality 0.55 (0.47-0.63) and 0.61 (0.53-0.70), respectively. Combining NGAL values with plasma creatinine did not improve AuROCs.Conclusion: In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses.",

keywords = "Acute Kidney Injury, Acute-Phase Proteins, Adult, Aged, Creatinine, Female, Humans, Lipocalins, Male, Middle Aged, Outcome Assessment (Health Care), Predictive Value of Tests, Prospective Studies, Proto-Oncogene Proteins, ROC Curve, Renal Replacement Therapy, Sepsis",

author = "Hjortrup, {P B} and N Haase and F Treschow and M{\o}ller, {M H} and A Perner",

note = "{\textcopyright} 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2015",

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doi = "10.1111/aas.12427",

language = "English",

volume = "59",

pages = "25--34",

journal = "Acta Anaesthesiologica Scandinavica",

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TY - JOUR

T1 - Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis

AU - Hjortrup, P B

AU - Haase, N

AU - Treschow, F

AU - Møller, M H

AU - Perner, A

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis.Methods: This was a prospective observational study in three general intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU, development of AKI according to the Kidney Disease: Improving Global Outcomes plasma creatinine criteria within 48 h and 90-day mortality.Results: Two-hundred- twenty-two patients had samples taken (211 had plasma and 162 urine sampled); simplified acute physiology score II was 54 (39-66). Forty patients (18%) had RRT in the ICU, 91 patients had AKI at enrolment; of the remaining 131 patients 24% developed AKI during the first 48 h, and 55% had died at 90 days. Areas under receiver-operating characteristics curve (AuROC) for predicting use of RRT in ICU were 0.70 (95% confidence interval 0.61-0.78) and 0.62 (0.51-0.73) for plasma and urine NGAL, respectively. AuROC of plasma and urine NGAL for AKI were 0.66 (0.54-0.77) and 0.71 (0.59-0.82), respectively, and for 90-day mortality 0.55 (0.47-0.63) and 0.61 (0.53-0.70), respectively. Combining NGAL values with plasma creatinine did not improve AuROCs.Conclusion: In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses.

AB - Background: The predictive value of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) for use of renal replacement therapy (RRT) and acute kidney injury (AKI) is not established in patients with severe sepsis.Methods: This was a prospective observational study in three general intensive care units (ICUs) in adult ICU patients with severe sepsis needing fluid resuscitation and a sub-study of the 6S trial. Plasma and urine were sampled at baseline and NGAL was measured using particle-enhanced turbidimetric immunoassay (The NGAL Test). Outcome measures were use of RRT in ICU, development of AKI according to the Kidney Disease: Improving Global Outcomes plasma creatinine criteria within 48 h and 90-day mortality.Results: Two-hundred- twenty-two patients had samples taken (211 had plasma and 162 urine sampled); simplified acute physiology score II was 54 (39-66). Forty patients (18%) had RRT in the ICU, 91 patients had AKI at enrolment; of the remaining 131 patients 24% developed AKI during the first 48 h, and 55% had died at 90 days. Areas under receiver-operating characteristics curve (AuROC) for predicting use of RRT in ICU were 0.70 (95% confidence interval 0.61-0.78) and 0.62 (0.51-0.73) for plasma and urine NGAL, respectively. AuROC of plasma and urine NGAL for AKI were 0.66 (0.54-0.77) and 0.71 (0.59-0.82), respectively, and for 90-day mortality 0.55 (0.47-0.63) and 0.61 (0.53-0.70), respectively. Combining NGAL values with plasma creatinine did not improve AuROCs.Conclusion: In ICU patients with severe sepsis, plasma and urine NGAL had low predictive power for use of RRT, AKI and 90-day mortality. These results were supported by sensitivity and exploratory analyses.

KW - Acute Kidney Injury

KW - Acute-Phase Proteins

KW - Adult

KW - Aged

KW - Creatinine

KW - Female

KW - Humans

KW - Lipocalins

KW - Male

KW - Middle Aged

KW - Outcome Assessment (Health Care)

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Proto-Oncogene Proteins

KW - ROC Curve

KW - Renal Replacement Therapy

KW - Sepsis

U2 - 10.1111/aas.12427

DO - 10.1111/aas.12427

M3 - Journal article

C2 - 25363361

SN - 0001-5172

VL - 59

SP - 25

EP - 34

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 1

ER -

Predictive value of NGAL for use of renal replacement therapy in patients with severe sepsis

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Keywords

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