Abstract
BackgroundThe performance of urinary N-acetyl-β-D-glucosaminidase (uNAG) for the detection of acute kidney injury (AKI) was controversial. uNAG is positively correlated with blood glucose levels. Hyperglycemia is common in the critically ill adults. The influence of blood glucose levels on the accuracy of uNAG in AKI detection has not yet been reported. The present study evaluated the effect of blood glucose levels on the diagnostic accuracy of uNAG to detect AKI.MethodsA total of 1585 critically ill adults in intensive care units at three university hospitals were recruited in this prospective observational study. uNAG, serum glucose, and glycosylated hemoglobin (HbA1c) were measured at ICU admission. Patients were categorized based on the history of diabetes and blood glucose levels. The performance of uNAG to detect AKI in different groups was assessed by the area under the receiver operator characteristic curve.ResultsFour hundred and twelve patients developed AKI, of which 109 patients were severe AKI. uNAG was significantly correlated with the levels of serum glucose (P < 0.001) and HbA1c (P < 0.001). After stratification based on the serum glucose levels, no significant difference was observed in the AUC of uNAG in detecting AKI between any two groups (P > 0.05). Stratification for stress hyperglycemic demonstrated similar results.However, among non-diabetic patients, the optimal cut-off value of uNAG for detecting AKI was higher in stress hyperglycemic patients as compared to those without stress hyperglycemia.ConclusionsThe blood glucose levels did not significantly affect the performance of uNAG for AKI detection in critically ill adults. However, the optimal cut-off value of uNAG to detect AKIwas affected by stress hyperglycemia in non-diabetic patients.
Highlights
The performance of urinary N-acetyl-β-D-glucosaminidase for the detection of acute kidney injury (AKI) was controversial. uNAG is positively correlated with blood glucose levels
Admission serum glucose and Glycosylated hemoglobin (HbA1c) levels were positively correlated with uNAG
Admission serum glucose and HbA1c levels did not have a significant impact on the discrimination accuracy of uNAG for AKI
Summary
The performance of urinary N-acetyl-β-D-glucosaminidase (uNAG) for the detection of acute kidney injury (AKI) was controversial. uNAG is positively correlated with blood glucose levels. The performance of urinary N-acetyl-β-D-glucosaminidase (uNAG) for the detection of acute kidney injury (AKI) was controversial. The influence of blood glucose levels on the accuracy of uNAG in AKI detection has not yet been reported. The present study evaluated the effect of blood glucose levels on the diagnostic accuracy of uNAG to detect AKI. Urinary N-acetyl-β-D-glucosaminidase (uNAG), originating from the lysosomes of the proximal tubule cells of the kidney, is a sensitive marker for AKI in clinical practice. Some studies reported a satisfactory discrimination of uNAG in the early detection of AKI in various patient populations [1, 13], while other studies found that uNAG had poor-tomoderate discrimination ability for AKI [15, 16]. These contradictory findings limit the application of uNAG in the early detection of AKI in clinical practice
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