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Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness

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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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Acknowledgments

The authors thank all the ICU physicians and staff for their compliance with the study. This work was presented in part at the Société de Réanimation de Langue Française 2012 meeting, in Paris. This study was supported by a grant from Alere Inc. Alere had no role in study design, data analysis, data interpretation or writing of the report. Xavier Valette and Damien du Cheyron had full access to all the data in the study and had final responsibility for the decision to submit for publication. Agreement to submit for publication was obtained from all the authors.

Conflicts of interest

The authors declare they have no conflict of interest.

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Authors and Affiliations

  1. Service de Réanimation Médicale, CHU de Caen, Av Côte de Nacre, 14000, Caen, France

    Xavier Valette, Cédric Daubin, Nicolas Terzi, Amélie Seguin, Pierre Charbonneau & Damien du Cheyron

  2. Département d’Anesthésie-Réanimation, CHU de Caen, 14000, Caen, France

    Benoit Savary, Véronique Pottier & Jean-Luc Hanouz

  3. Laboratoire de Biochimie A, CHU de Caen, 14000, Caen, France

    Marie Nowoczyn & Sabine Fradin

  4. Université de Caen Basse-Normandie, INSERM U1075, 14000, Caen, France

    Nicolas Terzi

  5. Université de Caen Basse-Normandie, EA3212, 14000, Caen, France

    Jean-Luc Hanouz

  6. Université de Caen Basse-Normandie, U2RM-EA 4655, Caen, 14000, France

    Damien du Cheyron

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  1. Xavier Valette
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Correspondence to Damien du Cheyron.

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Valette, X., Savary, B., Nowoczyn, M. et al. Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness. Intensive Care Med 39, 857–865 (2013). https://doi.org/10.1007/s00134-013-2826-y

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