The Outcome of Neutrophil Gelatinase-Associated Lipocalin-Positive Subclinical Acute Kidney Injury: A Multicenter Pooled Analysis of Prospective Studies

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• 作者：Michael Haase MD ; ^† ; ; Prasad Devarajan MD^‡ ; ; Anja Haase-Fielitz PharmD ; ^† ; ; Rinaldo Bellomo MD^§ ; ; ^{Rinaldo.Bellomo@austin.org.au} ; Dinna N. Cruz MD ; MPH ; Gebhard Wagener MD^¶ ; ; Catherine D. Krawczeski MD^‡ ; ; Jay L. Koyner MD^# ; Patrick Murray MD ; Michael Zappitelli MD ; MSc^† ; † ; ; Stuart L. Goldstein MD^‡ ; ‡ ; ; Konstantinos Makris PhD^§ ; § ; ; Claudio Ronco MD ; Johan Martensson MD ; Claes-Roland Martling MD ; Per Venge MD ; Edward Siew MD^¶ ; ¶ ; ; Lorraine B. Ware MD^¶ ; ¶ ; ; T. Alp Ikizler MD^¶ ; ¶ ; ; Peter R. Mertens MD^† ;
• 关键词：acute kidney injury (AKI) ; biomarker ; creatinine ; mortality ; neutrophil gelatinase-associated lipocalin (NGAL) ; renal replacement therapy (RRT)
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：26 April 2011
• 年：2011
• 卷：57
• 期：17
• 页码：1752-1761
• 全文大小：1495 K

文摘

Objectives

The aim of this study was to test the hypothesis that, without diagnostic changes in serum creatinine, increased neutrophil gelatinase-associated lipocalin (NGAL) levels identify patients with subclinical acute kidney injury (AKI) and therefore worse prognosis.

Background

Neutrophil gelatinase-associated lipocalin detects subclinical AKI hours to days before increases in serum creatinine indicate manifest loss of renal function.

Methods

We analyzed pooled data from 2,322 critically ill patients with predominantly cardiorenal syndrome from 10 prospective observational studies of NGAL. We used the terms NGAL(−) or NGAL(+) according to study-specific NGAL cutoff for optimal AKI prediction and the terms sCREA(−) or sCREA(+) according to consensus diagnostic increases in serum creatinine defining AKI. A priori-defined outcomes included need for renal replacement therapy (primary endpoint), hospital mortality, their combination, and duration of stay in intensive care and in-hospital.

Results

Of study patients, 1,296 (55.8 % ) were NGAL(−)/sCREA(−), 445 (19.2 % ) were NGAL(+)/sCREA(−), 107 (4.6 % ) were NGAL(−)/sCREA(+), and 474 (20.4 % ) were NGAL(+)/sCREA(+). According to the 4 study groups, there was a stepwise increase in subsequent renal replacement therapy initiation—NGAL(−)/sCREA(−): 0.0015 % versus NGAL(+)/sCREA(−): 2.5 % (odds ratio: 16.4, 95 % confidence interval: 3.6 to 76.9, p < 0.001), NGAL(−)/sCREA(+): 7.5 % , and NGAL(+)/sCREA(+): 8.0 % , respectively, hospital mortality (4.8 % , 12.4 % , 8.4 % , 14.7 % , respectively) and their combination (4-group comparisons: all p < 0.001). There was a similar and consistent progressive increase in median number of intensive care and in-hospital days with increasing biomarker positivity: NGAL(−)/sCREA(−): 4.2 and 8.8 days; NGAL(+)/sCREA(−): 7.1 and 17.0 days; NGAL(−)/sCREA(+): 6.5 and 17.8 days; NGAL(+)/sCREA(+): 9.0 and 21.9 days; 4-group comparisons: p = 0.003 and p = 0.040, respectively. Urine and plasma NGAL indicated a similar outcome pattern.

Conclusions

In the absence of diagnostic increases in serum creatinine, NGAL detects patients with likely subclinical AKI who have an increased risk of adverse outcomes. The concept and definition of AKI might need re-assessment.