Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness |
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Authors: | Xavier Valette Benoit Savary Marie Nowoczyn Cédric Daubin Véronique Pottier Nicolas Terzi Amélie Seguin Sabine Fradin Pierre Charbonneau Jean-Luc Hanouz Damien du Cheyron |
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Institution: | 1. Service de Réanimation Médicale, CHU de Caen, Av C?te de Nacre, 14000, Caen, France 2. Département d’Anesthésie-Réanimation, CHU de Caen, 14000, Caen, France 3. Laboratoire de Biochimie A, CHU de Caen, 14000, Caen, France 4. Université de Caen Basse-Normandie, INSERM U1075, 14000, Caen, France 5. Université de Caen Basse-Normandie, EA3212, 14000, Caen, France 6. Université de Caen Basse-Normandie, U2RM-EA 4655, Caen, 14000, France
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Abstract: | Purpose Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI). We evaluated the diagnostic and prognostic accuracies of plasma NGAL (pNGAL) for contrast-induced AKI (CI-AKI) in critically ill patients. Methods In a prospective observational study in two adult intensive care units in a university hospital, 100 consecutive critically ill patients with stable serum creatinine concentrations up to 48 h before contrast medium (CM) injection were enrolled. Serial blood sampling for pNGAL analysis was performed at enrolment, 2, 6, and 24 h after CM injection. The primary outcome was CI-AKI, defined by AKIN criteria, within the first 72 h following CM injection. Secondary outcomes were the need for renal replacement therapy (RRT) and mortality. Results Of the 98 patients analyzed, 30 developed CI-AKI. The pNGAL levels did not differ in patients with or without CI-AKI, and were higher in septic patients compared to nonseptic patients, and in patients with AKI preceding CM injection. The discriminative value of pNGAL to predict CI-AKI and mortality was poor; although, it did predict the need for RRT requirement after CM injection (area under receiver-operating characteristic curve, 0.85, 0.80, 0.83 and 0.86 at H0, H2, H6 and H24, respectively). Conclusion CI-AKI was common in critically ill patients. pNGAL levels were higher in patients with sepsis or previous AKI, but did not help to diagnose CI-AKI any earlier than serum creatinine after CM injection. However, pNGAL could be of interest to detect patients at risk of subsequent RRT requirement. |
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