Plasma and Urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) as Early Predictor of Acute Kidney Injury in Septic Patients

Introduction: Sepsis is an important precipitant of acute kidney injury (AKI). Septic AKI may be characterized by a distinct pathophysiology. The lack of an early and effective biomarker results in a significant delay in initiating appropriate therapy.Objective: to determine the role of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker of acute kidney injury in septic patients.Patients and methods: Prospective, observational study enrolled 40 critically ill patients with sepsis and septic shock. Plasma and urine NGAL were measured at enrollment and 12 h.Results: Seventeen (42.5%) patients developed AKI. Patients with AKI, compared to those without, had significantly higher severity of illness, organ dysfunction, length of ICU stay, and more ICU mortality. AKI patients, compared to those without, had significantly higher baseline plasma NGAL (221.4 ± 104.7 vs. 129.5 ± 48 ng/ml, p = 0.003), and at 12 h (239.2 ± 122.9 vs. 128.9 ± 49.1 ng/ml, p = 0.002) and significantly higher urine NGAL at baseline (13.6 ± 5.5 vs. 7.8 ± 3 ng/ml, p = 0.001), and at 12 h (23.2 ± 6.5 vs. 15 ± 4.9 ng/ml, p = 0.0001). Baseline plasma NGAL ≥ 147 ng/ml had sensitivity of 82.4% and specificity of 73.9% for predicting AKI (AuROC 0.82), and urine NGAL at 12 h ≥ 19 ng/ml had sensitivity of 82.4% and specificity of 78.3% (AuROC 0.82). Conclusion: Plasma and urine NGAL are good predictors of AKI in critically ill septic patients