Elderly is the main age group affected by acute kidney injury (AKI). There are no studies that investigated the predictive properties of urinary (u) NGAL as an AKI marker in septic elderly population. This study aimed to evaluate the efficacy of uNGAL as predictor of AKI diagnosis and prognosis in elderly septic patients admitted to ICUs. We prospectively studied elderly patients with sepsis admitted to ICUs from October 2014 to November 2015. Assessment of renal function was performed daily by serum creatinine and urine output. The level of uNGAL was performed within the first 48 hours of the diagnosis of sepsis (NGAL1) and between 48 and 96 hours (NGAL2). The results were presented using descriptive statistics and area under the receiver operating characteristic curve (AUC-ROC) and p value was 5%. Seventy-five patients were included, 47 (62.7%) developed AKI. At logistic regression, chronic kidney disease and low mean blood pressure at admission were identified as factors associated with AKI (OR=0.05, CI=0.01-0.60, p=0.045 and OR=0.81, CI=0,13-0.47; p=0.047). The uNGAL was excellent predictor of AKI diagnosis (AUC-ROC >0.95, and sensitivity and specificity>0.89), anticipating the AKI diagnosis in 2.1±0.3 days. Factors associated with mortality in the logistic regression were presence of AKI (OR=2.14, CI=1.42-3.98, p=0.04), chronic obstructive pulmonary disease (OR = 9.37, CI =1.79-49.1, p=0.008) and vasoactive drugs (OR=2.06, CI=0.98-1.02, p=0.04). The accuracy of NGALu 1 and 2 as predictors of death was intermediate, with AUC-ROC of 0.61 and 0.62; sensitivity between 0.65 and 0.77 and specificity lower than 0.6. The uNGAL was excellent predictor of AKI in septic elderly patients in ICUs and can anticipate the diagnosis of AKI in 2.1 days.
Table 1 Patients demographics and clinical characteristics (n=75).
Figure 1. Screening and enrollment.
Male sex n (%)
Comorbidities n (%)
Noradrenaline use n (%)
Mechanical ventilation n (%)
Urine output in 24h (ml)
Focus n (%):
KDIGO n (%):
Need for dialysis n (%)
Table 2 Patients demographics and clinical characteristics (n=75) according to outcome.
Figure 2. ROC analysis of uNGAL in septic elderly patients with AKI vs non-AKI. A) ROC analysis of uNGAL measured on first 48 hours of admission to ICU in septic elderly patients with AKI vs non-AKI. B) ROC analysis of uNGAL measured between 48-96 hours of admission to ICU in septic elderly patients with AKI vs non-AKI. C) ROC analysis of uNGAL/uCr measured on first 48 hours of admission to ICU in septic elderly patients with AKI vs non-AKI. D) ROC analysis of uNGAL/uCr measured between 48-96 hours of admission to ICU in septic elderly patients with AKI vs non-AKI.
(0.34 - 9.81)
(0.13 - 090)
(1.14 - 1.63)
(1.79 - 49.10)
(0.08 - 1.73)
(1.42 - 3.98)
Table 3 Multivariable analysis for AKI and death risk (n=75).
at moment 1 (<48h)*
at moment 2 (48-96h)
uNGAL /uCr (ng/mg):
at moment 1 (<48h)
at moment 2 (48-96h)
Table 4 Urinary NGAL values according to presence of acute kidney injury.
at moment 1 (<48h*)
at moment 2 (48-96h)
uNGAL /uCr (ng/mg)
at moment 1 (<48h)
at moment 2 (48-96h)
Table 5 Urinary NGAL values according to patient outcome.
Figure 3. ROC analysis of uNGAL in survivors versus non-survivor’s septic elderly patients. A) ROC analysis of uNGAL measured on first 48 hours of admission to ICU in survivors versus non-survivor’s septic elderly patients. B) ROC analysis of uNGAL measured between 48-96 hours of admission to ICU in survivors versus non-survivor’s septic elderly patients. C) ROC analysis of uNGAL/uCr measured on first 48 hours of admission to ICU in survivors versus non-survivor’s septic elderly patients. D) ROC analysis of uNGAL/uCr measured between 48-96 hours of admission to ICU in survivors versus non-survivor’s septic elderly patients
Table 6 Urinary NGAL sensitivity and specificity in septic elderly AKI patients (n=47).
Table 7 Urinary NGAL sensitivity and specificity in non-survival septic patients (n=35).
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