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Indexed neutrophil gelatinase associated lipocalin: a novel biomarker for the assessment of acute kidney injury

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Abstract

Introduction

Acute kidney injury (AKI) is a clinically relevant and common complication among patients with acute coronary syndrome. Neutrophil gelatinase-associated lipocalin (NGAL), secreted from different cells including renal tubules, has been widely studied as an early marker for kidney injury. However, chronic kidney disease (CKD) could impact NGAL levels and alter their predictive performance. Some studies attempted to address this issue by setting different cutoff values for patients with CKD, with limited success to date. Our aim was to evaluate a novel estimated glomerular filtration rate (eGFR)-adjusted “indexed NGAL” and its ability to predict in-hospital AKI among patients with ST elevation myocardial infarction.

Methods

We performed a prospective, observational, single center study involving patients with ST elevation myocardial infarction admitted to the coronary intensive care unit. Serum samples for baseline NGAL were collected within 24 h following hospital admission. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. In-hospital AKI was determined as occurring after ≥ 24 h from admission. To perform an individualized adjustment, we used the result of 24 h NGAL divided by the eGFR measured upon admission to the hospital (Indexed-NGAL; I-NGAL).

Results

Our cohort includes 311 patients, of whom 123 (40%) had CKD, and 66 (21%) suffered in-hospital AKI. NGAL levels as well as I-NGAL levels were significantly higher in patients with AKI (136 vs. 86, p < 0.01 and 3.13 VS. 1.06, p < 0.01, respectively). Multivariate analysis revealed I-NGAL to be independently associated with AKI (OR 1.34 (1.10–1.58), p < 0.01). I-NGAL had a higher predictive ability than simple NGAL results (AUC-ROC of 0.858 vs. 0.778, p < 0.001).

Conclusion

Adjusting NGAL values according to eGFR yields a new indexed NGAL value that enables better prediction of AKI regardless of baseline kidney function.

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Data availability

The data that support the findings of this study are not publicly available due to information that could compromise the privacy of research participants but are available from the corresponding author, SF, upon reasonable request.

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Funding

None, no funding was received for this study, all authors have nothing to declare.

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Authors and Affiliations

  1. Department of Cardiology, Tel-Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, Tel Aviv, Israel

    Shir Frydman, Ophir Freund, Lior Zornitzki, Haytham Abu Katash, Shmuel Banai & Yacov Shacham

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  1. Shir Frydman
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  2. Ophir Freund
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  3. Lior Zornitzki
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  4. Haytham Abu Katash
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  5. Shmuel Banai
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  6. Yacov Shacham
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Contributions

SF writing—original draft, data curation; OF statistical analysis, writing—original draft; LZ data curation, formal analysis, writing—review and editing; HAK writing—review and editing; SB methodology, writing—review and editing; YS conceptualization, methodology, writing—review and editing.

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Correspondence to Shir Frydman.

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Statement of ethics

Study protocol was reviewed and approved by the institutional ethics committee TLV-16-0224.

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Informed consent was obtained in writing from all participants.

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Frydman, S., Freund, O., Zornitzki, L. et al. Indexed neutrophil gelatinase associated lipocalin: a novel biomarker for the assessment of acute kidney injury. J Nephrol 37, 401–407 (2024). https://doi.org/10.1007/s40620-023-01800-y

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