Correlation between Neutrophil Gelatinase‐associated Lipocalin and highly sensitive C reactive protein as markers for early detection of acute kidney injury in neonatal sepsis.

Abstract

Introduction Sepsis is the commonest cause of neonatal mortality and is responsible for 30-50% of total neonatal deaths each year in developing countries. Neonatal sepsis is one of the commonest causes of Acute Kidney Injury (AKI) in newborns and it is associated with poor outcomes. Aim of the study To investigate the value of Neutrophil Gelatinase-associated Lipocalin and highly sensitive C reactive protein as markers for early detection of acute kidney injury in neonatal sepsis. Patients and Methods This prospective study was conducted on 50 neonates admitted to the Neonatal Intensive Care Unit with neonatal sepsis at our university hospital (GI) and 30 apparently healthy neonates matched for gestational age and weight as a control group (GII). The septic group (GI) included all neonates (age 5-28 days) with neonatal sepsis and were classified into two subgroups according to the presence of AKI. After detailed history and complete clinical examination, all cases were subjected to the following investigations: CBC, ABG, blood culture, serum electrolytes and creatinine, CRP, hs-CRP and NGAL. Results Only 64%of all septic cases showed positive qualitative CRP (> 6mg/L) while 86% of them showed positive hs-CRP of ( > 0.5mg/L) with highly significant differences (p < 0.001). Blood culture was positive only in 52% of cases. In this study, hs-CRP was significantly higher in septic neonates with AKI (27 cases) than those without AKI (16 cases) (p < 0.001). NGAL level was significantly higher in septic neonates than the control group (p < 0.001). Also NGAL level was markedly elevated in septic cases with AKI compared to non AKI subgroup with highly significant differences (p < 0.001).There was a positive correlation between NGAL and hs-CRP in septic cases with AKI. Conclusion Hs-CRP was proved to be very useful biochemical marker for early detection of neonatal sepsis compared to qualitative CRP. Serum NGAL and hs-CRP can be considered as very useful biochemical markers for early detection of AKI in septic neonates before any rise in serum creatinine.