Intensive Care Medicine

, Volume 36, Issue 3, pp 452–461

Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness

  • Sean M. Bagshaw
  • Michael Bennett
  • Michael Haase
  • Anja Haase-Fielitz
  • Moritoki Egi
  • Hiroshi Morimatsu
  • Giuseppe D’amico
  • Donna Goldsmith
  • Prasad Devarajan
  • Rinaldo Bellomo
Original

DOI: 10.1007/s00134-009-1724-9

Cite this article as:
Bagshaw, S.M., Bennett, M., Haase, M. et al. Intensive Care Med (2010) 36: 452. doi:10.1007/s00134-009-1724-9

Abstract

Objective

Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. We sought to determine whether there are unique patterns to plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in septic compared with non-septic AKI.

Design

Prospective observational study.

Setting

Two adult ICUs in Melbourne, Australia.

Patients

Critically ill patients with septic and non-septic AKI.

Interventions

None.

Measurements and main results

Blood and urine specimens collected at enrollment, 12, 24 and 48 h to measure plasma and urine NGAL. Eighty-three patients were enrolled (septic n = 43). Septic AKI patients had more co-morbid disease (p = 0.005), emergency surgical admissions (p < 0.001), higher illness severity (p = 0.008), more organ dysfunction (p = 0.008) and higher white blood cell counts (p = 0.01). There were no differences at enrollment between groups in AKI severity. Septic AKI was associated with significantly higher plasma (293 vs. 166 ng/ml) and urine (204 vs. 39 ng/mg creatinine) NGAL at enrollment compared with non-septic AKI (p < 0.001). Urine NGAL remained higher in septic compared with non-septic AKI at 12 h (p < 0.001) and 24 h (p < 0.001). Plasma NGAL showed fair discrimination for AKI progression (area under receiver-operator characteristic curve 0.71) and renal replacement therapy (AuROC 0.78). Although urine NGAL performed less well (AuROC 0.70, 0.70), peak urine NGAL predicted AKI progression better in non-septic AKI (AuROC 0.82).

Conclusion

Septic AKI patients have higher detectable plasma and urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.

Keywords

Acute kidney injury Critical illness Sepsis Urinary markers Fractional excretion of sodium Microscopy Neutrophil gelatinase-associated lipocalin 

Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Sean M. Bagshaw
    • 1
    • 2
  • Michael Bennett
    • 3
  • Michael Haase
    • 4
  • Anja Haase-Fielitz
    • 4
  • Moritoki Egi
    • 5
  • Hiroshi Morimatsu
    • 5
  • Giuseppe D’amico
    • 6
  • Donna Goldsmith
    • 2
  • Prasad Devarajan
    • 3
  • Rinaldo Bellomo
    • 2
  1. 1.Division of Critical Care Medicine, University of Alberta HospitalUniversity of AlbertaEdmontonCanada
  2. 2.Department of Intensive CareAustin HospitalMelbourneAustralia
  3. 3.Division of NephrologyCincinnati Children’s HospitalCincinnatiUSA
  4. 4.Department of Nephrology and Intensive CareCharite University HospitalBerlinGermany
  5. 5.Department of Anesthesiology and ResuscitologyOkayama University Medical SchoolOkayamaJapan
  6. 6.Intensive Care UnitPoliclinico CasilinoRomeItaly

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