Prognostic significance of urine neutrophil gelatinase-associated lipocalin in patients with septic acute kidney injury

Abstract

Acute kidney injury (AKI) is a common clinical problem which occurs in critically ill patients. Sepsis is now recognized as the most important contributing factor to AKI in this population. In clinical practice, certain studies have explored the urine neutrophil gelatinase-associated lipocalin (uNGAL) and the urine kidney injury molecule-1 (uKIM-1) as diagnostic and prognostic indices of AKI. Yet, it remains unclear whether uNGAL and uKIM-1 are associated with measures of disease severity and with adverse clinical outcomes in patients with established septic AKI of mixed cause and severity. Ninety-two septic patients with AKI were enrolled in a pilot study to test whether uKIM and uNGAL levels predict 180-day mortality. We initially performed univariate Cox proportional hazards analyses incorporating multiple demographic, clinical and laboratory variables. As a result, the APACHE II score (p= 0.014) and uNGAL (p= 0.015) were identified as independent predictors of 180-day mortality. On the other hand, there was no statistical difference in event-free survival between patients with and without higher serum creatinine, creatinine clearance and uKIM-1 (data not shown). In conclusion, uNGAL may be a promising predictor for septic patients with AKI, resulting in a clear increase in 180-day mortality. Further clinical evaluation of uNGAL is underway.