Plasma NGAL (Neutrophil Gelatinase Associated Lipocalin) Levels in Septic Patients With & Without Acute Kidney Injury: A Plausible Biomarker

Authors

  • Amber Naureen Department of Physiology, Fatima Jinnah Medical University, Lahore.
  • Maryam Rao Department of Physiology, King Edward Medical University, Lahore.
  • Farkhanda Naimat Department of Physiology, King Edward Medical University, Lahore.
  • Rahat Naseem Department of Physiology, King Edward Medical University, Lahore.
  • Qanita Mahmud Department of Physiology, Fatima Jinnah Medical University, Lahore.
  • Javaria Zafar Department of Physiology, Fatima Jinnah Medical University, Lahore.

DOI:

https://doi.org/10.47489/szmc.v38i2.475

Abstract

Introduction: Acute kidney injury is extremely common among septic patients. Its early recognition among critically ill patients can help in better prognosis and decrease the risk of longer hospital stay and dialysis requirement. Creatinine is considered as a gold standard for diagnosis of Acute Kidney Injury but it has its own disadvantages. New biomarkers for Acute Kidney Injury that can help in its early recognition are the need of time. Many plasma and urinary markers including Neutrophil Gelatinase Associated Lipocalin are being studied. Its role in earlier detection of septic Acute Kidney Injury in septic patients in our set of population still needs extensive research where incidence of sepsis associated complications leading to death is extremely high.

Aims and Objectives: To measure plasma Neutrophil Gelatinase Associated Lipocalin levels in septic patients with and without acute injury compare pNGAL levels in two groups, and to measure specificity and sensitivity of plasma Neutrophil Gelatinase Associated Lipocalin levels in both sets of patients.

Place and Duration of study: A cross sectional analytical study was carried out in National Health Research Complex, Shaikh Zayed Hospital, Lahore over a period of 3 years from 2016-2019

Material and Methods: This is a cross-sectional analytical study carried out in ninety two patients that are divided in two groups on the basis of creatinine levels measured at 72hrs. First group consists of septic patients who developed Acute Kidney Injury (AKI) and second group consists of septic patients Without Acute Kidney Injury(WAKI). Plasma NGAL levels are compared in two groups. SPSS v 20 was used for analysis, p-value ? 0.05 was considered significant. Results: The plasma NGAL level at 24 hours for group without Acute Kidney Injury was 126.4±15.4 ng/ml and for the group which developed Acute kidney Injury was 191.1±15.9 ng/ml and the difference was clearly significant with p- value <0.001.

Conclusion: pNGAL levels are significantly raised than the cut-off value of 150ng/ml at 0hrs in septic patients who developed AKI as compared to septic patients who didn’t develop AKI.

References

Xu L, Sun P. Identification and management of sepsis associated-acute kidney injury. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Feb;35(2):221-224.

Mercado MG, Smith DK, Guard EL. Acute Kidney Injury: Diagnosis and Management. Am Fam Physician. 2019 Dec 1;100(11):687-694.

Yang Y, Dong J, Chen X, Chen R, Wang H. Incidence, risk factors and clinical outcomes of septic acute renal injury in cancer patients with sepsis admitted to the ICU: A retrospective study. Front Med (Lausanne). 2022 Dec 14;9:1015735.

Aslan A, van den Heuvel MC, Stegeman CA, et al. Kidney histopathology in lethal human sepsis. Crit Care. 2018;22:359.

Peerapornratana S, Manrique-Caballero CL, Gómez H, Kellum JA. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019 Nov;96(5):1083-1099.

Zarbock A, Nadim MK, Pickkers P, Gomez H, Bell S, Joannidis M, Kashani K, Koyner JL, Pannu N, Meersch M, Reis T. Sepsis-associated acute kidney injury: consensus report of the 28th Acute Disease Quality Initiative workgroup. Nat Rev Nephrol. 2023 Jun;19(6):401-417.

Chang YM, Chou YT, Kan WC, Shiao CC. Sepsis and Acute Kidney Injury: A Review Focusing on the Bidirectional Interplay. Int J Mol Sci. 2022 Aug 15;23(16):9159.

Chen L, Wu X, Qin H, Zhu H. The PCT to Albumin Ratio Predicts Mortality in Patients With Acute Kidney Injury Caused by Abdominal Infection- Evoked Sepsis. Frontiers in Nutrition. 2021;8(179).

Ragán D, Horváth-Szalai Z, Szirmay B, Mühl D. Novel Damage Biomarkers of Sepsis-Related Acute Kidney Injury. EJIFCC. 2022 Apr 11;33(1):11-22.

Romejko K, Markowska M, Niemczyk S. The Review of Current Knowledge on Neutrophil Gelatinase-Associated Lipocalin (NGAL). Int J Mol Sci. 2023 Jun 21;24(13):10470.

Chen J.J., Lee T.H., Lee C.C., Chang C.H. Using lipocalin as a prognostic biomarker in acute kidney injury. Expert. Rev. Mol. Diagn. 2021;21:455–464.

Wen Y., Parikh C.R. Current concepts and advances in biomarkers of acute kidney injury. Crit. Rev. Clin. Lab. Sci. 2021;58:354–368.

Ntrinias T., Papasotiriou M., Balta L., Kalavrizioti D., Vamvakas S., Papachristou E., Goumenos D.S. Biomarkers in Progressive Chronic Kidney Disease. Still a Long Way to Go. Prilozi. 2019;40:27–39.

Mathieu Buonafine , Ernesto Martinez-Martinez, Frédéric Jaisser. More than a simple biomarker: the role of NGAL in cardiovascular and renal diseases Review Clin Sci (Lond) . 2018 May 8;132(9):909- 923.

Gomes BC, Silva Júnior JM, Tuon FF. Evaluation of Urinary NGAL as a Diagnostic Tool for Acute Kidney Injury in Critically Ill Patients With Infection: An Original Study. Can J Kidney Health Dis. 2020 Jun 19;7:2054358120934215.

Törnblom S, Nisula S, Petäjä L, Vaara ST, Haapio M, Pesonen E, Pettilä V; FINNAKI study group. Urine NGAL as a biomarker for septic AKI: a critical appraisal of clinical utility-data from the observational FINNAKI study. Ann Intensive Care. 2020 Apr 28;10(1):51.

Molinari L, Del Rio-Pertuz G, Smith A, Landsittel DP, Singbartl K, Palevsky PM, Chawla LS, Huang DT, Yealy DM, Angus DC, Kellum JA; ProCESS and ProGReSS-AKI Investigators. Utility of Biomarkers for Sepsis-Associated Acute Kidney Injury Staging. JAMA Netw Open. 2022 May 2;5(5)

Nikolas T, O’ Rourke M, Yang J, Meghan E, et al. Sensitivity and specificity of single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Annals of Internal Medicine. 2008;148:810-19.

Khawaja, S., Jafri, L., Siddiqui, I. et al. The utility of neutrophil gelatinase-associated Lipocalin (NGAL) as a marker of acute kidney injury (AKI) in critically ill patients. Biomark Res 7, 4 (2019). https://doi.org/10.1186/s40364-019-0155-1

Bansal N, Matheny ME, Greevy RA Jr, Eden SK, Perkins AM, Parr SK, Fly J, Abdel-Kader K, Himmelfarb J, Hung AM, Speroff T, Ikizler TA, Siew ED. Acute Kidney Injury and Risk of Incident Heart Failure Among US Veterans. Am J Kidney Dis. 2018 Feb;71(2):236-245.

Shapiro NI, Trzeciak S, Hollander JE, Birkhahn R, Otero R, Osborn TM, et al. The diagnostic accuracy of plasma neutrophil gelatinase – associated lipocalin in the prediction of acute kidney injury in emergency department patients with suspected sepsis. Infect Dis. 2010;56(1):52-9.

Martensson J, Bell M, Oldner A, Xu S, Venge P, Martling CR. Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury. Intensive Care Med. 2010; 36:1333-40.

Md Ralib A, Mat Nor MB, Pickering JW. Plasma Neutrophil Gelatinase-Associated Lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis. Nephrology (Carlton). 2017 May;22(5):412-419

Downloads

Published

2024-04-29

How to Cite

1.
Amber Naureen, Maryam Rao, Farkhanda Naimat, Rahat Naseem, Qanita Mahmud, Javaria Zafar. Plasma NGAL (Neutrophil Gelatinase Associated Lipocalin) Levels in Septic Patients With & Without Acute Kidney Injury: A Plausible Biomarker. Proceedings S.Z.M.C [Internet]. 2024 Apr. 29 [cited 2024 Dec. 4];38(2):138-43. Available from: https://proceedings-szmc.org.pk/index.php/szmc/article/view/475