Neutrophil Gelatinase-associated Lipocalin In Patients Research Articles

Clinical Impacts of Urinary Neutrophil Gelatinase-Associated Lipocalin in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention.

Chronic kidney disease (CKD) is associated with poor prognosis in patients undergoing percutaneous coronary intervention (PCI). Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker for renal injury. However, the association between urinary NGAL concentrations and renal and cardiovascular events in patients with CKD undergoing PCI has not been elucidated. This study investigated the clinical impact of urinary NGAL concentrations on renal and cardiovascular outcomes in patients with non-dialysis CKD undergoing PCI.Methods and Results: We enrolled 124 patients with non-dialysis CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) undergoing elective PCI. Patients were divided into low and high NGAL groups based on the median urinary NGAL concentration measured the day before PCI. Patients were monitored for renal and cardiovascular events during the 2-year follow-up period. Kaplan-Meier analyses showed that the incidence of renal and cardiovascular events was higher in the high than low NGAL group (log-rank P<0.001 and P=0.032, respectively). Multivariate Cox proportional hazards analyses revealed that urinary NGAL was an independent risk factor for renal (hazard ratio [HR] 4.790; 95% confidence interval [CI] 1.537-14.924; P=0.007) and cardiovascular (HR 2.938; 95% CI 1.034-8.347; P=0.043) events. Urinary NGAL could be a novel and informative biomarker for predicting subsequent renal and cardiovascular events in patients with CKD undergoing elective PCI.

Evaluation of diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin in patients with symptoms of urinary tract infections: a meta-analysis.

Early and accurate diagnosis of urinary tract infection (UTI) can prevent serious sequelae including chronic kidney disease. Multiple individual studies have identified urine neutrophil gelatinase-associated lipocalin (uNGAL) as a promising biomarker for early diagnosis of UTI. We sought to understand the distribution and diagnostic accuracy of uNGAL values in patients presenting with UTI symptoms. Our systematic literature reviews in PubMed, Embase, and Cochrane Reviews up to March 2024, identified 25 studies reporting mean/median, standard deviation/quartiles, and detection limits of uNGAL in symptomatic patients with and without culture-confirmed UTI. Seventeen studies were in children. Meta-analyses were performed using the quantile estimation (QE) method estimating the distributions of uNGAL, which were then compared between the UTI and non-UTI groups for identifying the best cut-off points maximizing the Youden index. Sensitivity analyses were performed on all 25 studies including adult patients. We found that uNGAL levels were significantly higher in samples with confirmed UTI compared to those without. In pediatric studies, median and 95% confidence interval (CI) of uNGAL values were 22.41 (95% CI of 9.94, 50.54) ng/mL in non-UTI group vs. 118.85 (95% CI of 43.07, 327.97) ng/mL in UTI group. We estimated the cut-off point of 48.43 ng/mL with highest sensitivity (96%) and specificity (97%) in children. Sensitivity analysis including both pediatric and adult studies yielded similar results. The level of uNGAL in symptomatic patients with confirmed UTI is much higher than that reported in patients without UTI. It may be used as a diagnostic tool to identify UTI early among symptomatic patients. The range of uNGAL concentrations and cut-off points reported in subjects with UTI is much lower than that reported in patients with acute intrinsic kidney injury. https://www.crd.york.ac.uk/, PROSPERO (CRD42023370451).

Correlation of Serum Neutrophil Gelatinaseassociated Lipocalin with Clinical Severity Score in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Acute Coronary Syndrome (ACS) is a term that encompasses various clinical presentations such as ST-Segment Elevation Myocardial Infarction (STEMI), Non STEMI (NSTEMI), or unstable angina. Neutrophil Gelatinase-associated Lipocalin (NGAL), also known as lipocalin-2, belongs to the lipocalin category of extracellular proteins. Recent research indicates that NGAL levels are increased in different cardiac situations, regardless of the presence of acute renal injury. Aim: To compare the levels of serum NGAL and Global Registry of Acute Coronary Events (GRACE) scores between cases with ACS and Angio-negative cases, and to study the correlation of serum NGAL with the GRACE score (clinical severity score) in ACS patients. Materials and Methods: A cross-sectional study was conducted with 128 patients at the Department of Biochemistry, MKCG Medical College and Hospital, Berhampur, Odisha, India, presenting to the Cardiac Emergency Department from November 2020 to August 2021. Coronary Angiograms (CAG) were done to confirm the presence of Coronary Artery Disease (CAD), and patients were grouped accordingly as Group-1 with ACS patients and Group-2 with angiogram-negative cases. Apart from the routine work-up, including serum urea and creatinine, serum electrolytes, fasting blood sugar, lipid profile, and management, all patients underwent determination of serum NGAL levels and GRACE score at admission. The data were analysis using student’s t-test and Pearson’s correlation test. Results: Among the 128 participants (64 cases in Group-1 and 64 cases in Group-2), Group-1 comprised 37 cases of STEMI, 26 cases of NSTEMI, and one case of unstable angina. Serum NGAL levels were significantly elevated in patients with CAGproven ACS (140.89±56.47 ng/mL) without any renal dysfunction, sepsis, or overt infection compared to patients without CAD on CAG (52.01±18.39 ng/mL) (p&lt;0.0001). The serum NGAL level exhibited a positive correlation of 0.359 (p=0.004) with the severity of ACS, as measured by the GRACE score. Conclusion: The present study suggests that serum NGAL in patients with ACS may serve as a potential novel biomarker for risk stratification and predicting the severity of the disease.

Neutrophil Gelatinase-Associated Lipocalin in Peritoneal Dialysis-Related Peritonitis: Correlation with White Blood Cells over Time and a Possible Role as the Outcome Predictor

Introduction: The present study aimed to monitor peritoneal neutrophil gelatinase-associated lipocalin (pNGAL) during peritonitis episodes and to enhance its diagnostic value by evaluating pNGAL at scheduled times in parallel with white blood cell (WBC) count. In addition, we investigated possible correlations between pNGAL and the etiology of peritonitis, evaluating it as a possible marker of the clinical outcome. Methods: Twenty-two patients with peritoneal dialysis (PD)-related peritonitis were enrolled. Peritonitis was divided into Gram-positive, Gram-negative, polymicrobial, and sterile. WBC count and neutrophil gelatinase-associated lipocalin (NGAL) in PD effluent were measured at different times (days 0, 1, 5, 10, 15, and/or 20 and 10 days after antibiotic therapy discontinuation). NGAL was measured by standard quantitative laboratory-based immunoassay and by colorimetric NGAL dipstick (NGALds) (dipstick test). Results: We found strong correlations between peritoneal WBC, laboratory-based NGAL, and NGALds values, both overall and separated at each time point. On day 1, we observed no significant difference in WBC, both NGALds (p = 0.3, 0.9, and 0.2) between Gram-positive, Gram-negative, polymicrobial, and sterile peritonitis. No significant difference has been found between de novo versus relapsing peritonitis for all markers (p > 0.05). We observed a parallel decrease of WBC and both NGAL in patients with favorable outcomes. WBC count and both pNGAL resulted higher in patients with negative outcomes (defined as relapsing peritonitis, peritonitis-associated catheter removal, peritonitis-associated hemodialysis transfer, peritonitis-associated death) at day 10 (p = 0.04, p = 0.03, and p = 0.05, respectively) and day 15 (p = 0.01, p = 0.04, and tendency for p = 0.005). There was a tendency toward higher levels of WBC and NGAL in patients with a negative outcome at day 5. No significant difference in all parameters was proven at day 1 (p = 0.3, p = 0.9, p = 0.2) between groups. Conclusion: This study confirms pNGAL as a valid and reliable biomarker for the diagnosis of PD-peritonitis and its monitoring. Its trend is parallel to WBC count during peritonitis episodes, in particular, patients with unfavorable outcomes.

Diagnostic and prognostic performance of urinary neutrophil gelatinase-associated lipocalin in patients with cirrhosis and acute kidney injury.

Acute kidney injury (AKI) commonly occurs in patients with decompensated cirrhosis. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) could help discriminate between different etiologies of AKI. The aim of this study was to investigate the use of uNGAL in (1) the differential diagnosis of AKI, (2) predicting the response to terlipressin and albumin in patients with hepatorenal syndrome-AKI (HRS-AKI), and (3) predicting in-hospital mortality in patients with AKI. One hundred sixty-two consecutive patients with cirrhosis and AKI were included from 2015 to 2020 and followed until transplant, death, or 90 days. Standard urinary markers and uNGAL were measured. Data on treatment, type, and resolution of AKI were collected. Thirty-five patients (21.6%) had prerenal AKI, 64 (39.5%) HRS-AKI, 27 (16.7%) acute tubular necrosis-AKI (ATN-AKI), and 36 (22.2%) a mixed form of AKI. Mean values of uNGAL were significantly higher in ATN-AKI than in other types of AKI (1162 ng/ml [95% CI 423-2105 ng/ml] vs. 109 ng/ml [95% CI 52-192 ng/ml]; p < 0.001). uNGAL showed a high discrimination ability in predicting ATN-AKI (area under the receiver operating characteristic curve, 0.854; 95% CI 0.767-0.941; p < 0.001). The best-performing threshold was found to be 220 ng/ml (sensitivity, 89%; specificity, 78%). The same threshold was independently associated with a higher risk of nonresponse (adjusted OR [aOR], 6.17; 95% CI 1.41-27.03; p = 0.016). In multivariable analysis (adjusted for age, Model for End-Stage Liver Disease, acute-on-chronic liver failure, leukocytes, and type of AKI), uNGAL was an independent predictor of in-hospital mortality (aOR, 1.74; 95% CI 1.26-2.38; p = 0.001). uNGAL is an adequate biomarker for making a differential diagnosis of AKI in cirrhosis and predicting the response to terlipressin and albumin in patients with HRS-AKI. In addition, it is an independent predictor of in-hospital mortality.

Prognostic role of neutrophil gelatinase-associated lipocalin in patients with coronary artery disease and abdominal obesity

Aim. To study the prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) as a marker of adverse cardiovascular events (CVEs) in patients with coro­nary artery disease (CAD) associated with abdominal obesity (AO).Material and methods. This 12-month prospective study included 68 patients diagnosed with CAD who were hospitalized for elective percutaneous coronary intervention (PCI). The median age was 61 [55;65] years. Depending on the presence of obesity according to the World Health Organization (1999) criteria, patients were divided into 2 groups. The 1st group included 30 patients with AO, while the 2nd group — 38 patients without obesity. Patients were measured for waist circumference and hip circumference, and waist-to-hip ratio was calculated. Lipid profile and NGAL concentration were determined. During the study, body mass index (BMI), visceral adiposity index (VAI), triglycerides (TG)/glucose index, lipid accumulation product (LAP), metabolic index (MI), TG to high-density lipoprotein cholesterol ratio (HDL-C). During this period, data was collected on the disease course and intervention outcome. After 12 months an extended examination was performed to assess the endpoints.Results. During the follow-up period, unfavorable cardiovascular events in the 1st group of patients were registered in 33,3% of patients, and in the 2nd group — in 26,3%. In the group of patients with obesity, higher values of anthropometric indices and NGAL were established. The concentration of NGAL has the highest correlation with BMI, MI, LAP and slightly less with total cholesterol and VAI levels. The analysis showed that NGAL &gt;47,1 ng/ml is a predictor of adverse CVEs in patients with CAD and obesity after PCI.Conclusion. Thus, NGAL has the highest correlation with the following indices: BMI, MI, LAP, total cholesterol, and VAI. NGAL &gt;47,1 ng/ml is a predictor of adverse CVEs in patients with CAD and obesity after PCI. NGAL may serve as a promising marker for predicting adverse CVEs. This biomarker already at the stage of hos­pitalization can assess the risk adverse outcomes in patients with CAD and AO, including those who underwent PCI.

Comparison of Biomarkers to Differentiate Chronic Kidney Disease and Chronic Kidney Disease of Unknown Etiology

Chronic kidney disease of unknown etiology (CKDU) is prevalent and clinically silent until its late stages at which patient may suffer significant irreversible damage, or mortality in the absence of early screening and intervention. CKDU is asymptomatic but may show nonspecific symptoms. Conventional markers are influenced by multiple non-renal factors while Kidney injury molecule-1(KIM-1) and Neutrophil gelatinase-associated lipocalin(NGAL) are promising biomarkers of chronic kidney disease (CKD), there are no studies reported so far on these markers in CKDU. The aim of the study is to assess the sensitivity of biomarkers serum KIM-1 and NGAL in patients with CKDU in comparison with CKD and controls. To achieve this, our objectives are to estimate the level of biochemical parameters like serum creatinine, urea, uric acid, random blood sugar, systolic and diastolic blood pressure and hemoglobin and to compare novel biomarkers KIM-1 and NGAL in CKDU patients with CKD. The serum levels of urea, uric acid, creatinine, KIM-1 and NGAL were estimated in control, CKD and CKDU (n = 35, 46, 79 respectively). Creatinine showed 8.1-fold and 2.7-fold increase (P &lt;0.001), and urea 4.0% and 1.8% increase (P &lt; 0.001), compared to control in CKD and CKDU cohorts, respectively. The sensitivity and specificity of KIM-1 was 73.4% and 67.4%with a cutoff value of 203.5ng/mL using the receiver operating characteristic(ROC) curve. For NGAL they were 82.3%, 73.9% and 255ng/mL. Compared to control, KIM-1 showed a 51.5-fold and 87.2-fold increase in CKD and CKDU, respectively (P &lt; 0.001). NGAL showed a 4.8-fold and 6.7-fold increase in CKD and CKDU, respectively (P &lt; 0.001). Creatinine and urea were higher in CKD than in CKDU, whereas KIM-1 and NGAL were higher in CKDU than CKD. KIM-1 and NGAL are sensitive biomarkers for CKDU. KIM-1 can differentiate CKD and CKDU.&#x0D;

Prognostic value of plasma neutrophil gelatinase-associated lipocalin for cardiovascular events in patients with chronic heart failure and atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. We aimed to assess the prognostic value of plasma neutrophil gelatinase-associated lipocalin (NGAL), a marker of renal tubular damage, in patients with heart failure with or without atrial fibrillation (AF). Methods The study involved 113 (83.2% men) patients with mean age 60.0 [54.0-67.0] years with II-IV functional class (recommendations of the New York Heart Association) is due to ischemic heart disease. Serum levels of NGAL were quantified by ELISA. Echocardiography was performed according to the American Society of Echocardiography/European Association of Echocardiography recommendations. Receiver operating characteristic (ROC) curve analysis was used to determine the best NGAL cut-off to predict events. Cox proportional hazards models were used to investigate the prospective association between NGAL and events during follow-up. Outcome was cumulative incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke, HF hospitalization) at 36 months. Results Median plasma NGAL in patients with and without AF was 34 (25-46) ng/ml and 26 (18-44) ng/ml, p&amp;lt;0.01, respectively. The ROC curve showed an optimal admission NGAL level cut-off &amp;gt;25.5 ng/mL, with 70% sensitivity and 89% specificity. The area under the ROC curve (AUC) was (0.814; p&amp;lt;0.01). In patients with CHF and atrial fibrillation multivariable analysis shows, that NGAL independently associated with outcomes (HR 2.35, 95% CI 1.2-4.61; p&amp;lt;0.01). Conclusions Admission plasma NGAL &amp;gt;25.5 ng/ml appears a sensible tool for in-hospital AF prediction as well as an marker for adverse cardiovascular outcome during long-term follow-up period.

Diagnostic and prognostic role of urinary Neutrophil Gelatinase-associated Lipocalin in patients with cirrhosis and acute kidney injury

Background: Acute Kidney Injury (AKI) commonly occurs in patients with decompensated cirrhosis. Urinary Neutrophil Gelatinase-associated Lipocalin (uNGAL) could help in discriminating between different etiologies of AKI. The aim of this study was to investigate the use of uNGAL in: a) differential diagnosis of AKI; b) predicting the response to terlipressin and albumin in patients with Hepatorenal Syndrome (HRS-AKI); c) predicting in-hospital and 90-day mortality.

Serum Neutrophil Gelatinase-Associated Lipocalin Levels in Acute Brucellosis and Brucellar Spondylodiscitis

Brucellosis is a zoonotic infectious disease caused by Brucella spp., an intracellular bacterium. The complications of acute Brucellosis may affect all organs and systems. The most common complication of the disease is musculoskeletal system involvement. The neutrophil gelatinase-associated lipocalin (NGAL) is a marker of neutrophil formation and acts as a siderophore-binding protein to prevent bacterial iron uptake and its use as a marker in the diagnosis and follow-up of bacterial infections is being investigated. The aim of this study was to measure the serum levels of NGAL in patients with acute Brucellosis and Brucellar spondylodiscitis, and to determine whether there is a correlation between NGAL levels and the progression and complications of the disease. This prospective case control study was conducted with 240 patients and 120 healthy controls. The diagnosis of acute Brucellosis was established when a person was asked to take an STA test due to clinical symptoms within the past eight weeks, and the test result that exceeded 1/160, or a 4-fold titer increase was found in the STA test after an interval of two weeks, and/or there was Brucella spp. growth in the blood culture. A contrasted lumbar magnetic resonance (MR) scan was performed on patients diagnosed with acute Brucellosis who had lower back pain. Presence of spondylodiscitis was assessed radiologically with contrasted lumbar MR images. NGAL levels were determined with ELISA assay. The median NGAL value was found to be 456.67 ng/L (101.41-5804.41 ng/L) in patients with acute Brucellosis and 113.84 ng/L (58.29-542.34 ng/L) in the control group. The median NGAL value was statistically higher in the patients than the control group (p= 0.001). Brucellar spondylodiscitis was detected in 57 (23.7%) of 240 patients diagnosed with acute Brucellosis. The median NGAL value was 1885.62 ng/L (143.21-5804.41 ng/L) in patients with Brucellar spondylodiscitis, and 356.87 ng/L (101.41-1874.07 ng/L) in those who did not have Brucellar spondylodiscitis. This difference was statistically significant (p= 0.001). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values were found to be higher in patients who had Brucellar spondylodiscitis. Blood cultures were drawn from 186 (77.5%) of the 240 patients diagnosed with acute Brucellosis. The blood culture positivity rate was 36.02%. Patients whose blood cultures were positive had higher NGAL levels (p= 0.001). The blood culture positivity rate was higher in patients who were diagnosed with Brucellar spondylodiscitis (p= 0.001). A regression analysis showed that female gender and high levels of NGAL, ESR, and alanine aminotransferase (ALT) could be used as predictors of Brucellar spondylodiscitis. The explanatoriness of the model was 82.3%. Although determination of NGAL levels is seen as a useful marker in the diagnosis of acute Brucellosis and predicting the presence of Brucellar spondylodiscitis, more comprehensive studies are required to be used in clinical practice in regions where Brucellosis is endemic.

Comparative evaluation of cystatin C and neutrophil gelatinase-associated lipocalin in patients with thalassemia major versus thalassemia intermedia

Kidney disorders are long-term complications in thalassemia patients, especially with the high life expectancy of these patients. Proper evaluation of kidney impairment in β-thalassemia patients can be difficult due to higher intake of iron chelators, resulting in renal impairment. Early biomarkers of renal disease are used for the diagnosis of tubular and glomerular abnormalities. The current study was conducted on 88 individuals, 25 healthy people and 63 β-thalassemia patients. Circulating levels of urea, creatinine, cystatin C and neutrophil gelatinase-associated lipocalin were measured in all groups. Compared to healthy control, patients with thalassemia major and intermedia showed a significant increase in both cystatin C and NGAL levels, with no effects on creatinine levels. Furthermore, urea levels were markedly higher in patients with thalassemia major compared to control. As early renal dysfunction markers, cystatin C and NGAL should be routinely evaluated in thalassemia patients major and intermedia.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) measured at admission is associated with development of late cardiogenic shock and mortality in patients with STEMI

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Rigshospitalets Forskningsfond (Grant number: 07IO) Hjerteforeningen (Grant number A6024) Lundbeckfonden (Grant number R186-2015-2132) BACKGROUND In patients with ST-elevation myocardial infarction (STEMI) increased inflammatory response is associated with development of cardiogenic shock (CS). Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a glycoprotein released from mature neutrophils and the plasma concentration of NGAL likely increases immediately after STEMI. PURPOSE We aimed to assess whether admission NGAL plasma concentration in patients with STEMI was associated with CS development after leaving the catheterization laboratory (late CS) and 30-day all-cause mortality. MATERIALS AND METHODS From 1892 consecutive patients with STEMI 1626 (86%) had plasma NGAL concentration measured upon hospital admission before angiography throughout a 1-year period at two tertiary heart centers in Denmark. Patients were stratified according to NGAL quartiles (Q1-4). To assess late CS development, we adjusted for the Observatoire Régional Breton sur l’Infarctus (ORBI) risk score for late CS. For mortality assessment, we adjusted for gender, age, post-PCI culprit Thrombolysis in myocardial infarction (TIMI) flow, left ventricular ejection fraction (LVEF), kidney dysfunction, admission lactate concentration and being comatose after cardiac arrest. RESULTS Increasing NGAL concentration was associated with higher age, more comorbidities (hypertension, diabetes, heart failure, previous stroke, and kidney dysfunction) and more critical patient conditions at presentation including lower blood pressure and LVEF. Plasma NGAL concentration was associated with both late CS development and 30-day mortality (Figure). When adjusted for factors associated with poor outcome, NGAL remained independently associated with both late CS development (Q4 vs. Q1-3) (OR (95% CI) 2.64 (1.57-6.03)) and 30-day mortality (HR (95% CI) 3.18 (1.46-6.93)). CONCLUSION High admission plasma concentration of NGAL in patients with STEMI was independently associated late CS development and 30-day all-cause mortality. Abstract Figure. NGAL quartiles and late CS/mortality

Serum neutrophil gelatinase-associated lipocalin and oxidized neutrophil proteins in patients with nephropathy caused by acute alcohol poisoning

Introduction: Alcohol use has been identified as a major risk factor for disease burden and premature mortality. Objectives: We studied the serum neutrophil gelatinase-associated lipocalin (NGAL) and advanced oxidation protein product (AOPP) concentrations in neutrophils to assess the possibility of their using for the early detection of kidney damage in patients with acute alcohol poisoning (AAP). The impact of eGFR (estimated glomerular filtration rate) on the NGAL and AOPP levels was also studied. Patients and Methods: The study included 89 patients with AAP. Healthy individuals and patients with chronic kidney disease (CKD) served as comparison groups. Participants were represented by men, aged between 20 and 40 years. Results of laboratory tests of kidney function were also taken into account. Serum NGAL level was measured using ELISA kit. AOPP was determined using the method of Witko-Sarsat et al. Results: We detected a significant increase in serum NGAL and AOPP level both in toxic nephropathy with a clinical picture of acute kidney injury (AKI) and in the preclinical stage of kidney damage. Hence a single trend in the changes of these indicators existed in patients with AAP. At the same time, our study revealed opposite trends in patients with CKD. There was no significant increase in serum NGAL in patients with CKD. Conclusion: We propose to consider an increased eGFR together with an increased serum NGAL concentration in patients with AAP as the stage, preceding the nephropathy or AKI, even in the absence of clinical and laboratory signs of impaired renal function.

Association of plasma and urine NGAL with acute kidney injury after elective colorectal surgery: A cohort study

BackgroundAcute kidney injury (AKI) is common in surgical patients. We aimed to investigate the validity of plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in the detection of AKI and prediction of outcomes in patients undergoing major colorectal surgery. Materials and methodsThis was a pre-specified post-hoc analysis of a randomized controlled trial comparing oesophageal doppler and Lithium dilution cardiac output monitoring in high risk patients undergoing major colorectal surgery as part of an Enhanced Recovery After Surgery protocol in a tertiary care hospital. Plasma and urine samples for NGAL measurement were taken before surgery (T1), immediately after surgery (T2), and on postoperative day 1 (T3). AKI was defined according to the KDIGO criteria. ResultsA total of 89 patients were included of whom 12 (13.5%) developed AKI. Plasma NGAL significantly increased from T1 to T3 in both AKI (p < 0.001) and non-AKI (p = 0.048) patients, while urine NGAL did not change over time. There were no significant differences in plasma and urine NGAL in patients with and without AKI at all time points. Postoperative day 1 urine NGAL concentrations were significantly higher in non-survivors than survivors (41.2 versus 25 ng/mL, p = 0.026). One-year mortality was significantly higher in AKI patients with a raised urine NGAL compared to AKI patients without elevated urine NGAL levels. ConclusionsPlasma and urine NGAL poorly predicted AKI post-colorectal surgery. Non-survivors had higher urine NGAL results. More research is required to explore the association between NGAL and long-term outcomes.

Mortality Prediction of Serum Neutrophil Gelatinase-Associated Lipocalin in Patients Requiring Continuous Renal Replacement Therapy

Mortality Prediction of Serum Neutrophil Gelatinase-Associated Lipocalin in Patients Requiring Continuous Renal Replacement Therapy

Mortality prediction of serum neutrophil gelatinase-associated lipocalin in patients requiring continuous renal replacement therapy.

Background/AimsWe investigated whether serum neutrophil gelatinase-associated lipocalin (NGAL) can predict mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT).MethodsThis study enrolled 169 patients who underwent serum NGAL testing at CRRT initiation from June 2017 to January 2019. The predictive power of serum NGAL level for 28-day mortality was compared to the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score and Sequential Organ Failure Assessment (SOFA) score via area under the receiver operating characteristic curve (AuROC) value.ResultsThere were 55 survivors and 114 non-survivors at 28 days post-CRRT initiation. Median serum NGAL level was significantly higher in the non-survivor group than in the survivor group (743.0 ng/mL vs. 504.0 ng/mL, p = 0.003). The AuROC value of serum NGAL level was 0.640, which was lower than APACHE-II score and SOFA score values (0.767 and 0.715, respectively). However, in the low APACHE-II score group (< 27.5), AuROC value of serum NGAL was significantly increased (0.698), and it was an independent risk factor for 28 day-mortality (hazard ratio, 2.405; 95% confidence interval, 1.209 to 4.783; p = 0.012).ConclusionsIn patients with AKI requiring CRRT, serum NGAL levels may be useful for predicting short-term mortality in those with low APACHE-II scores.

The Role of Serum Neutrophil Gelatinase-associated Lipocalin in the Early Diagnosis of Nephropathy in Patients with Acute Alcohol Poisoning

AIM: In our study, we assessed the possibility of using the serum neutrophil gelatinase-associated lipocalin (NGAL) for the early detection of kidney damage in patients with acute alcohol poisoning (AAP).&#x0D; METHODS: The study included 89 patients and 30 healthy donors. All participants in the study were mostly represented by men (90%) aged between 20 and 40 years. The influence of alcohol poisoning severity was also taken into account in the study. The Human NGAL ELISA Kit was used for the quantitative detection of serum NGAL. We also evaluated the main laboratory indicators of kidney functions, including eGFR (calculated according to serum creatinine).&#x0D; RESULTS: We did not find a correlation between blood alcohol concentration and serum NGAL level; also, alcohol poisoning severity did not affect the NGAL values. The results of our study showed the possibility of using the serum NGAL in patients with AAP to detect the preclinical stage of reduced renal function, until the moment when it can be diagnosed with using only serum creatinine.&#x0D; CONCLUSION: We propose to consider an increase in eGFR together with an increase in serum NGAL in this group of patients as a stage, preceding nephropathy, even in the absence of clinical and laboratory signs of impaired renal function.

Diagnostic Accuracy of Cerebrospinal Fluid Neutrophil Gelatinase-Associated Lipocalin in Patients with Acute Bacterial Meningitis: A Prospective Cohort Study

Background: It is difficult for early differential diagnosis between bacterial meningitis (BM) and tuberculous meningitis (TBM) or cryptococcal meningitis (CM).Therefore, a novel and reliable biomarker is urgently required. Neutrophil Gelatinase-Associated Lipocalin (NGAL) have been reported as a novel biomarker for differentiating the bacterial or viral infections, however, whether the CSF NGAL is a potential biomarker for distinguishing between BM and TBM or CM are not reported. Methods: Prospectively enrolled the patients with suspected CNS infections at admission, and divided them into three case groups: BM (n=47), TBM (n=34), CM (n=30), and a hospitalized control (HC, n=39). Detected the CSF NGAL and evaluate the diagnostic accuracy to distinguish between BM and TBM or CM. Meanwhile, longitudinally measured the CSF NGAL of BM to evaluate whether it would be a monitor of the antibacterial treatment. Results: The CSF NGAL in BM was significantly higher than TBM, CM and HC, and the serum NGAL was not significantly different among three case groups. The ROC analysis showed that CSF NGAL presented a good diagnostic performance with an AUC of 0.907(95% CI: 0.830 to 0.985), and at the optimal cutoff value of 16.55 ng/mL with 88.46% sensitivity and 81.25% specificity for discriminating BM from TBM or CM. Meanwhile, the CSF NGAL in convalescent period of BM was significantly lower than the acute period. Conclusion: CSF NGAL could be used as an early diagnostic biomarker of BM, especially when compared with TBM or CM, and it also might be have some important clinical value for monitoring antibiotic therapy of BM. Funding Statement: The study was supported in part by the grants from the National Natural Science Foundation of China (No.81802088), the Joint Funds for the innovation of science and Technology, Fujian Province (No.2018Y9080), the Natural Science Foundation of Fujian Province (No.2016J05185), and the Youth Foundation of Health and Family Planning Commission of Fujian Province (No.2016-1-55). Declaration of Interests: The authors: No reported conflicts of interest. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Fujian Medical University. Written informed consent was obtained from the participants or their surrogates prior to the study.

Assessment of serum and urinary levels of neutrophil gelatinase-associated lipocalin in correlation with albuminuria in nondiabetic obese patients

BackgroundObesity, a new pandemic, is associated with an increased risk of death and morbidity. Obesity-related glomerulopathy is an increasing cause of end-stage renal disease. Neutrophil gelatinase-associated lipocalin (NGAL) is a neutrophil-expressed inflammatory protein that is increased in different diseases. The objective of the current study was to evaluate the predictive performance of serum and urinary NGAL in obese patients and to clarify its possible relationship with different stages of albuminuria in nondiabetic patients.Patients and methodsThis cross-sectional study was conducted on 55 obese patients and 40 healthy individuals as a control group. The enrolled patients were divided into three groups according to the level of albuminuria. Serum and urinary NGAL (ng/ml) were measured by enzyme-linked immunosorbent assay kits.ResultsSerum and urinary NGAL levels were significantly higher in obese (354.44±121.2 and 213.22±10.8, respectively) compared with healthy controls (44.21±11.2 and 13.9±6.3, respectively; P<0.001). Moreover, there were higher significant values of serum NGAL in patients with macroalbuminuria (488.65±44.53) and microalbuminuria (264.33±25.53) compared with patients with normoalbuminuria (122.48±4.53, P<0.001) and higher significant values of urinary NGAL in patients with macroalbuminuria (363.84±32.53) and microalbuminuria (112.19±26.53) compared with patients with normoalbuminuria (32.17±10.53, P<0.001). Serum and urinary NGAL levels were statistically significant predictors of albuminuria among obese patients. In addition, our results observed that BMI, waist/hip ratio, urinary albumin, estimated glomerular filtration rate, and urinary albumin-creatinine ratio were independently correlated with serum NGAL, whereas BMI, waist/hip ratio, and urinary albumin were the only variables that were independently correlated with urinary NGAL.ConclusionThe higher levels of serum and urinary NGAL in obese patients compared with healthy group were strongly correlated with urinary albumin-creatinine ratio and cardiometabolic risk factors.

Association of neutrophil-gelatinase-associated lipocalin with microvascular complications in patients with type 2 diabetes: a cross-sectional study

Eighty-two patients with type 2 diabetes were enrolled in our study. Urinary microalbumine and NGAL levels were measured in urine samples over 24 hours. We also studied NGAL levels in serum. All patients went through an ophthalmologic examination. The results were evaluated based on the presence of microalbuminuria and retinopathy. There were no significant differences in serum and urine NGAL levels between normoalbuminuric (n = 66) and microalbuminuric (n = 16) patients. We also did not find any significant difference in patients with retinopathy (n = 16) or without retinopathy (n = 66). There are controversial findings about the role of NGAL in diabetic patients in medical literature. Standard values of urine and serum NGAL levels have yet to be determined. Our study suggests that NGAL is not a useful marker to differentiate microalbuminuric patients from normoalbuminuric subjects. We also did not find a relationship between NGAL levels and the presence of retinopathy. Additional studies with larger sample sizes will be required to confirm or refute these findings.