The value of urine neutrophil gelatinase-associated lipocalin in the prediction of septic acute kidney injury, dialysis need, and mortality in a cohort of Eegyptian sepsis patients

Abstract

Aim The aim of this study was to assess the role of urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL) in the early diagnosis of septic acute kidney injury (AKI) in critically ill Egyptian adults.Patients and Methods The studied patients were categorized into three groups: sepsis–non-AKI; sepsis–AKI; and nonsepsis–non-AKI. Urine samples were collected daily for 5 days from the sepsis patients. For the sepsis–non-AKI patients urine NGAL levels were measured from samples taken on the admission day and on day 5. In the sepsis–AKI patients, urine NGAL levels were measured from samples taken on the admission day, from samples collected 24 h before the onset of AKI, and from those taken on the day of AKI onset. For nonsepsis–non-AKI patients, urine NGAL levels were measured from samples taken on the admission day only.Results Totally, 172 patients were studied: 61 in the sepsis–non-AKI group; 82 in the sepsis–AKI group; and 29 in the nonsepsis–non-AKI group. Urine NGAL was significantly higher in sepsis patients than in nonsepsis patients (14.8±4.2 and 5.5±2.6 ng/ml, respectively; P<0.001). In sepsis patients who developed AKI, urine NGAL preceded the rise in serum creatinine, and at its cutoff level of 33.1 ng/ml it predicted AKI with an area under the curve of 0.96, sensitivity of 99%, and specificity of 85%; at its cutoff level of 48.7 ng/ml, it predicted the need for dialysis with an area under the curve of 0.81, sensitivity of 84%, and specificity of 73%. Urine NGAL could not predict mortality among sepsis patients.Conclusion Urine NGAL predicted AKI well in critically ill septic patients and predicted their need for dialysis.