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Aging and Disease    2018, Vol. 9 Issue (2) : 182-191     DOI: 10.14336/AD.2017.0307
Orginal Article |
Urinary Neutrophil Gelatinase-Associated Lipocalin Is Excellent Predictor of Acute Kidney Injury in Septic Elderly Patients
Erica Pires da Rocha,Lais Gabriela Yokota,Beatriz Motta Sampaio,Karina Zanchetta Cardoso Eid,Dayana Bitencourt Dias,Fernanda Moreira de Freitas,Andre Luis Balbi,Daniela Ponce
University Sao Paulo State-UNESP, Distrito de Rubiao Junior, without number, Botucatu, Sao Paulo, Brazil
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Abstract  

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.

Keywords elderly      acute kidney injury      biomarker      NGAL     
Corresponding Authors: Daniela Ponce   
Issue Date: 01 April 2018
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Erica Pires da Rocha
Lais Gabriela Yokota
Beatriz Motta Sampaio
Karina Zanchetta Cardoso Eid
Dayana Bitencourt Dias
Fernanda Moreira de Freitas
Andre Luis Balbi
Daniela Ponce
Cite this article:   
Erica Pires da Rocha,Lais Gabriela Yokota,Beatriz Motta Sampaio, et al. Urinary Neutrophil Gelatinase-Associated Lipocalin Is Excellent Predictor of Acute Kidney Injury in Septic Elderly Patients[J]. A&D, 2018, 9(2): 182-191.
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http://www.aginganddisease.org/EN/10.14336/AD.2017.0307     OR     http://www.aginganddisease.org/EN/Y2018/V9/I2/182
[1] Mayr VD, Dünser MW, Greil V, Jochberger S, Luckner G, Ulmer H, et al (2006). Causes of death and determinants of outcome in critically ill patients. Crit Care, 10: R154
[2] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001). Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med, 9: 1303-10.
[3] Silva E, Pedro M de A, Sogayar ACB, Mohovic T, Silva CL de O, Janiszewski M, et al. (2004). Brazilian Sepsis Epidemiological Study (BASES study). Crit Care, 8(4): R251-60.
[4] Lentini P, de Cal M, Clementi A, D’Angelo A, Ronco C (2012). Sepsis and AKI in ICU Patients: The Role of Plasma Biomarkers. Crit Care Res Pract, 856401.
[5] Zarjou A, Agarwal A (2011). Sepsis and acute kidney injury. J Am Soc Nephrol JASN, 22(6): 999-1006.
[6] Murray PT, Devarajan P, Levey AS, Eckardt KU, Bonventre JV et al (2008). A framework and key research questions in aki diagnosis and staging in different environments. Clin J Am Soc Nephrol, 3(3): 864-8.
[7] Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, et al (2005). Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet, 365(9466): 1231-8.
[8] Wagener G, Jan M, Kim M, Mori K, Barasch JM, Sladen RN, et al (2006). Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology, 105(3): 485-91.
[9] Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH, Ma Q et al (2007). NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol Berl Ger, 22(12): 2089-95.
[10] Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Pawlak K, Mysliwiec M, et al (2007). Could neutrophil-gelatinase-associated lipocalin and cystatin C predict the development of contrast-induced nephropathy after percutaneous coronary interventions in patients with stable angina and normal serum creatinine values?. Kidney Blood Press Res, 30(6): 408-15.
[11] Xu SY, Pauksen K, Venge P (1995). Serum measurements of human neutrophil lipocalin (HNL) discriminate between acute bacterial and viral infections. Scand J Clin Lab Invest, 55(2): 125-31.
[12] Fjaertoft G, Foucard T, Xu S, Venge P (2005). Human neutrophil lipocalin (HNL) as a diagnostic tool in children with acute infections: a study of the kinetics. Acta Paediatr Oslo Nor, 94(6): 661-6.
[13] Mori K, Lee HT, Rapoport D, Drexler IR, Foster K, Yang J, et al (2005). Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest, 115(3): 610-21.
[14] Devarajan P (2014). NGAL for the detection of acute kidney injury in the emergency room. Biomark Med, 8(2): 217-9.
[15] Wheeler DS, Devarajan P, Ma Q, Harmon K, Monaco M, Cvijanovich N, et al (2008). Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med, 36(4): 1297-303.
[16] Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, et al (2007). Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care Lond Engl, 11(4): R84.
[17] Bagshaw SM, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H, et al (2010). Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med, 36(3): 452-61.
[18] Mårtensson J, Bell M, Oldner A, Xu S, Venge P, Martling CR (2010). Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury. Intensive Care Med, 36(8): 1333-40
[19] Dellinger RP, Levy MM, Rhodes A et al (2013). International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 41(2): 580-637.
[20] Abdel-Rahman EM, Okusa MD (2014). Effects of aging on renal function and regenerative capacity. Nephron Clin Prac, 127:15-20
[21] Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999). A More Accurate Method to Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation. Ann Intern Med,130: 461-70.
[22] Siew ED, Matheny ME, Ikizler TA et al (2010). Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. Kidney Int, 77: 536-42.
[23] Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury (2012). Kidney Int Suppl, 1-138.
[24] Rosner ACMH, Cruz DN, Ronco C (2010). Acute kidney injury in elderly intensive care patients: a review. Intensive Care Med, 36:1454-64.
[25] Medeiros P, Nga H S, Menezes P, Bridi R, Balbi AL, Ponce D (2015). Acute kidney injury in septic patients admitted to emergency clinical room: risk factors and outcome. Clin Exp Nephrol, 19:859-66.
[26] Chao CT, Lin YF, Tsai HB, Wu VC, Ko WJ (2013). Acute kidney injury network staging in geriatric postoperative acute kidney injury patients: shortcomings and improvements. J Am Coll Surg, 217(2): 240-50.
[27] Chao TC, Tsai HB, Wu CH, Hsu, Lin YF, Chen JS (2015). Cross-sectional study of the association between functional status and acute kidney injury in geriatric patients. BMC Nephrology, 16:186
[28] USRDS Annual Report. Acute kidney injury (2013). Am J Kidney Dis, 61: e97-108.
[29] Pascual J, Liano F (1998). Causes and prognosis of acute renal failure in the very old. Madrid Acute Renal Failure Study Group. J Am Geriatr Soc, 46:721-5.
[30] Gong Y, Zhang F, Ding F, Gu Y (2012). Elderly patients with acute kidney injury (AKI): Clinical features and risk factors for mortality. Arch Gerontol Geriatr, 54: e47-e51
[31] Mahajan S, Tiwar S, Bhowmik D, Agarwal SK, Tiwari SC, Dash SC (2006). Factors affecting the outcome of acute renal failure among the elderly population in India: a hospital based study. Int Urol Nephrol, 38: 391-6.
[32] Cao Y, Wang RH (2017). Associations among Metabolism, Circadian Rhythm and Age-Associated Diseases. Aging Dis, 2017, 8(3): 314-333.
[33] Sesso R, Roque A, Vicioso B, Stella S (2004). Prognosis of ARF in hospitalized elderly patients. Am J Kidney Dis, 44, 410-9.
[34] Kohli HS, Bhat A, Aravindan SudK, Jha V, Gupta KL, Sakhuja V (2006). Spectrum of renal failure in elderly patients. Int Urol Nephrol, 38: 759-65
[35] Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al (2003). Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol, 14(10): 2534-43.
[36] Mishra J, Mori K, Ma Q, Kelly C, Barasch J, Devarajan P (2004). Neutrophil gelatinase-associated lipocalin: a novel early urinary biomarker for cisplatin nephrotoxicity. Am J Nephrol, 24(3):307-15.
[37] Trachtman H, Christen E, Cnaan A, Patrick J, Mai V, Mishra J, et al (2006). Urinary neutrophil gelatinase-associated lipocalcin in D+HUS: a novel marker of renal injury. Pediatr Nephrol Berl Ger, 21(7):989-94
[38] Royakkers AA, Bouman CS, Stassen PM, Korevaar JC, Binnekade JM, et al (2012). Systemic and urinary neutrophil gelatinase-associated lipocalins are poor predictors of acute kidney injury in unselected critically ill patients. Crit Care Res Pract, 712695.
[39] Si NH, Medeiros P, Menezes P, Bridi R, Balbi A, Ponce D (2015). Sepsis and AKI in clinical emergency room patients: the role of urinary Ngal. Biomed Res Int, 2015: 413751
[40] Zhang A, Cai Y, Wang P, Qu J, Luo Z, Chen X, et al. (2016). Diagnosis and prognosis of neutrophil gelatinase-associated lipocalin for acute kidney injury with sepsis: a systematic review and meta-analysis. Crit Care, 20: 41.
[41] Collins SP, Hart KW, Lindsell CJ, Fermann GJ, Weintraub NL, Miller KF, et al (2012). Elevated urinary neutrophil gelatinase-associated lipocalcin after acute heart failure treatment is associated with worsening renal function and adverse events. Eur J Heart Fail, 14(9):1020-9.
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