The nature and discriminatory value of urinary neutrophil gelatinase-associated lipocalin in critically ill patients at risk of acute kidney injury.

Details

Serval ID
serval:BIB_AF180093C6FD
Type
Article: article from journal or magazin.
Collection
Publications
Title
The nature and discriminatory value of urinary neutrophil gelatinase-associated lipocalin in critically ill patients at risk of acute kidney injury.
Journal
Intensive Care Medicine
Author(s)
Glassford N.J., Schneider A.G., Xu S., Eastwood G.M., Young H., Peck L., Venge P., Bellomo R.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
39
Number
10
Pages
1714-1724
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
BACKGROUND: Different molecular forms of urinary neutrophil gelatinase-associated lipocalin (NGAL) have recently been discovered. We aimed to explore the nature, source and discriminatory value of urinary NGAL in intensive care unit (ICU) patients.
METHODS: We simultaneously measured plasma NGAL (pNGAL), urinary NGAL (uNGAL), and estimated monomeric and homodimeric uNGAL contribution using Western blotting-validated enzyme-linked immunosorbent assays [uNGAL(E1) and uNGAL(E2)] and their calculated ratio in 102 patients with the systemic inflammatory response syndrome and oliguria, and/or a creatinine rise of >25 μmol/L.
MEASUREMENTS AND MAIN RESULTS: Bland-Altman analysis demonstrated that, despite correlating well (r = 0.988), uNGAL and uNGAL(E1) were clinically distinct, lacking both accuracy and precision (bias: 266.23; 95% CI 82.03-450.44 ng/mg creatinine; limits of agreement: -1,573.86 to 2,106.32 ng/mg creatinine). At best, urinary forms of NGAL are fair (area under the receiver operating characteristic [AUROC] ≤0.799) predictors of renal or patient outcome; most perform significantly worse. The 44 patients with a primarily monomeric source of uNGAL had higher pNGAL (118.5 ng/ml vs. 72.5 ng/ml; p < 0.001), remaining significant following Bonferroni correction.
CONCLUSIONS: uNGAL is not a useful predictor of outcome in this ICU population. uNGAL patterns may predict distinct clinical phenotypes. The nature and source of uNGAL are complex and challenge the utility of NGAL as a uniform biomarker.
Keywords
APACHE, Acute Kidney Injury/diagnosis, Acute Kidney Injury/etiology, Acute-Phase Proteins/urine, Aged, Area Under Curve, Biological Markers/blood, Biological Markers/urine, Blotting, Western, Creatinine/blood, Critical Illness, Female, Humans, Intensive Care Units/statistics & numerical data, Lipocalins/blood, Lipocalins/urine, Male, Middle Aged, Oliguria/complications, Oliguria/diagnosis, Predictive Value of Tests, Prospective Studies, Risk Assessment/methods, Systemic Inflammatory Response Syndrome/complications, Systemic Inflammatory Response Syndrome/diagnosis, Victoria
Pubmed
Web of science
Create date
26/11/2014 21:26
Last modification date
20/08/2019 15:18
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