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Mortality prediction of serum neutrophil gelatinase-associated lipocalin in patients requiring continuous renal replacement therapy.

ABSTRACT:

Background/aims

We investigated whether serum neutrophil gelatinase-associated lipocalin (NGAL) can predict mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).

Methods

This study enrolled 169 patients who underwent serum NGAL testing at CRRT initiation from June 2017 to January 2019. The predictive power of serum NGAL level for 28-day mortality was compared to the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score and Sequential Organ Failure Assessment (SOFA) score via area under the receiver operating characteristic curve (AuROC) value.

Results

There were 55 survivors and 114 non-survivors at 28 days post-CRRT initiation. Median serum NGAL level was significantly higher in the non-survivor group than in the survivor group (743.0 ng/mL vs. 504.0 ng/mL, p = 0.003). The AuROC value of serum NGAL level was 0.640, which was lower than APACHEII score and SOFA score values (0.767 and 0.715, respectively). However, in the low APACHE-II score group (< 27.5), AuROC value of serum NGAL was significantly increased (0.698), and it was an independent risk factor for 28 day-mortality (hazard ratio, 2.405; 95% confidence interval, 1.209 to 4.783; p = 0.012).

Conclusion

In patients with AKI requiring CRRT, serum NGAL levels may be useful for predicting short-term mortality in those with low APACHE-II scores.

SUBMITTER: Park Y

PROVIDER: S-EPMC7969065 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Continuous renal replacement therapy (CCRT) is a frequently used modality for the support of intensive care patients with acute kidney injury (AKI). Nevertheless, there are no objective criteria for the discontinuation of CRRT. The purpose of this study was to investigate whether urine neutrophil gelatinase-associated lipocalin (uNGAL) alone or in combination with urine output could be used as a diagnostic test for renal function recovery in ICU patients on CRRT. METHODS:This was a single-centre prospective observational study including patients with acute kidney failure needing CRRT. Sixty-nine patients were enrolled, and 54 completed the study. Of the 54 patients, 22 recovered renal function (REC), defined as dialysis independency at 72?h from discontinuation, while 32 patients did not (NREC). Urine NGAL was measured at 0, 6, 12, and 24?h after CRRT discontinuation. The cumulated urine output was measured for 24?h prior to discontinuation and at 6, 12, and 24?h after discontinuation. Missing uNGAL values were calculated by interpolation. The Youden's index was used to calculate cut-off values in order to define uNGAL and urine output single variable and 2-variable diagnostic tests with the optimum prediction of successful CRRT discontinuation. RESULTS:Baseline characteristics at CRRT initiation were similar between groups. Compared to the NREC group, the REC group had significantly higher urine output (p?<?0.0001) and lower uNGAL (p?<?0.001) at all time points, except for uNGAL at 24?h (p?<?0.24). The best uNGAL predictor for successful CRRT discontinuation was uNGAL at 6?h after discontinuation (predictive value 80%). The best single predictor was cumulated urine output 24?h before discontinuation (predictive value 85%). The combinations of uNGAL at 6?h (cut-off 1650??g/L) with cumulated urine output 24?h prior to discontinuation (cut-off 210?ml) proved to be the superior tests (using either "or" or "and"), with predictive values of 93% (successful CRRT discontinuation) and 92% (dialysis dependency). CONCLUSIONS:With a predictive value of 93%, the combination of uNGAL at 6?h after and the cumulated urine output 24?h prior to CRRT cessation proved to be the best diagnostic test for successful CRRT discontinuation in ICU patients. CLINICAL TRIAL REGISTRATION:N/A.