The correlation between the human neutrophil gelatinase-associated lipocalin and the extravascular lung water index being analysised in patients with acute lung injury

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Objective To study whether there is a correlation between the content of neutrophil gelatinase-asociated lipocalin(NGAL) and extravascular lung water index(EVLWI) in patients with acute lung injury(ALI) induced by septic shock . Methods We prospectively collected 110 patients with septic shock from December 2013 to June 2015, who had already completed the initial fluid resuscitation within 6 hours according to the guide. In accordance with whether combined with ALI, patients were divided into two groups: non ALI group was A group (n=61), and ALI group was B group (n=49). Baseline information, EVLWI and other indexes of hemodynamic monitored by PICCO of each group was collected prior to admission in intensive care unit. EVWI and the content of NGAL in alveolar lavage fluid, which detected by ELISA, were gathered after the initial fluid resuscitation. Results There were no significant differences at the baseline level between the two groups (P>0.05). The risk factors of EVLWI in patients with septic shock were analyzed by multivariate linear regression analysis.The risk factors contained fluid balance, NGAL, cardiac index(CI), Global end diastolic volume index(GEDI), human albumin(ALB), globulin(GLO). The results showed that EVLWI had linear regression with NGAL and GEDI. The equation of linear regression were Y(NGAL)=2.017+ 0.035X, and Y(GEDI)=-0.671+ 0.004X, respectively.Correlation analysis indicated that there was significantly positive correlation between EVLWI and GEDI(r=0.835, P=0.000) and between NGAL and GEDI(r=0.489, P=0.000). In contrast, after immobilization of GEDI, we did not find any significant correlation between EVLWI and NGAL(r=0.381, P=0.060). Conclusions In case of fluid infusion volume is relatively too much , there is a strong correlation between NGAL in alveolar lavage fluid and EVLWI levels for early fluid resuscitation in patients with sepetic shock. Key words: Intensive care unit; Sepsis; Septic shock; Acute lung injury; Bronchoalveolar lavage fluid; Extravascular lung water index; Neutrophil gelatinase-associated lipocalin; PICCO