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01-05-2013 | Original

Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness

Authors: Xavier Valette, Benoit Savary, Marie Nowoczyn, Cédric Daubin, Véronique Pottier, Nicolas Terzi, Amélie Seguin, Sabine Fradin, Pierre Charbonneau, Jean-Luc Hanouz, Damien du Cheyron

Published in: Intensive Care Medicine | Issue 5/2013

Abstract

Purpose

Neutrophil gelatinase-associated lipocalin (NGAL) is a promising biomarker for acute kidney injury (AKI). We evaluated the diagnostic and prognostic accuracies of plasma NGAL (pNGAL) for contrast-induced AKI (CI-AKI) in critically ill patients.

Methods

In a prospective observational study in two adult intensive care units in a university hospital, 100 consecutive critically ill patients with stable serum creatinine concentrations up to 48 h before contrast medium (CM) injection were enrolled. Serial blood sampling for pNGAL analysis was performed at enrolment, 2, 6, and 24 h after CM injection. The primary outcome was CI-AKI, defined by AKIN criteria, within the first 72 h following CM injection. Secondary outcomes were the need for renal replacement therapy (RRT) and mortality.

Results

Of the 98 patients analyzed, 30 developed CI-AKI. The pNGAL levels did not differ in patients with or without CI-AKI, and were higher in septic patients compared to nonseptic patients, and in patients with AKI preceding CM injection. The discriminative value of pNGAL to predict CI-AKI and mortality was poor; although, it did predict the need for RRT requirement after CM injection (area under receiver-operating characteristic curve, 0.85, 0.80, 0.83 and 0.86 at H0, H2, H6 and H24, respectively).

Conclusion

CI-AKI was common in critically ill patients. pNGAL levels were higher in patients with sepsis or previous AKI, but did not help to diagnose CI-AKI any earlier than serum creatinine after CM injection. However, pNGAL could be of interest to detect patients at risk of subsequent RRT requirement.

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Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, Laghi F, Magder S, Papazian L, Pelosi P, Polderman KH (2010) An Official ATS/ERS/ESICM/SCCM/SRLF Statement: Prevention and Management of Acute Renal Failure in the ICU Patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med 181:1128–1155PubMedCrossRef

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Critical Care (London, England) 11:R31

Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure–definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Critical care (London, England) 8:R204-212

Solomon R, Dauerman HL (2011) Contrast-induced acute kidney injury. Circulation 122:2451–2455CrossRef

Haveman JW, Gansevoort RT, Bongaerts AH, Nijsten MW (2006) Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast: a retrospective analysis. Intensive Care Med 32:1199–1205PubMedCrossRef

Hoste EA, Doom S, De Waele J, Delrue LJ, Defreyne L, Benoit DD, Decruyenaere J (2012) Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis. Intensive Care Med 37:1921–1931CrossRef

Huber W, Eckel F, Hennig M, Rosenbrock H, Wacker A, Saur D, Sennefelder A, Hennico R, Schenk C, Meining A, Schmelz R, Fritsch R, Weiss W, Hamar P, Heemann U, Schmid RM (2006) Prophylaxis of contrast material-induced nephropathy in patients in intensive care: acetylcysteine, theophylline, or both? A randomized study. Radiology 239:793–804PubMedCrossRef

Huber W, Jeschke B, Page M, Weiss W, Salmhofer H, Schweigart U, Ilgmann K, Reichenberger J, Neu B, Classen M (2001) Reduced incidence of radiocontrast-induced nephropathy in ICU patients under theophylline prophylaxis: a prospective comparison to series of patients at similar risk. Intensive Care Med 27:1200–1209PubMedCrossRef

Lakhal K, Ehrmann S, Chaari A, Laissy JP, Regnier B, Wolff M, Pajot O (2011) Acute Kidney Injury Network definition of contrast-induced nephropathy in the critically ill: incidence and outcome. J Crit Care 26:593–599PubMedCrossRef

10.

Polena S, Yang S, Alam R, Gricius J, Gupta JR, Badalova N, Chuang P, Gintautas J, Conetta R (2005) Nephropathy in critically Ill patients without preexisting renal disease. Proc West Pharmacol Soc 48:134–135PubMed

11.

Rashid AH, Brieva JL, Stokes B (2009) Incidence of contrast-induced nephropathy in intensive care patients undergoing computerised tomography and prevalence of risk factors. Anaesth Intensive Care 37:968–975PubMed

12.

Valette X, Parienti JJ, Plaud B, Lehoux P, Samba D, Hanouz JL (2011) Incidence, morbidity, and mortality of contrast-induced acute kidney injury in a surgical intensive care unit: A prospective cohort study. J of crit care Oct 25.:[Epub ahead of print]

13.

Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, Ikizler TA, Paganini EP, Mehta RL (2010) Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Critical Care (London, England) 14:R82

14.

Siew ED, Ware LB, Ikizler TA (2011) Biological markers of acute kidney injury. J Am Soc Nephrol 22:810–820PubMedCrossRef

15.

Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, Barasch J, Devarajan P (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 14:2534–2543PubMedCrossRef

16.

Mori K, Lee HT, Rapoport D, Drexler IR, Foster K, Yang J, Schmidt-Ott KM, Chen X, Li JY, Weiss S, Mishra J, Cheema FH, Markowitz G, Suganami T, Sawai K, Mukoyama M, Kunis C, D’Agati V, Devarajan P, Barasch J (2005) Endocytic delivery of lipocalin-siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Investig 115:610–621PubMed

17.

Schmidt-Ott KM, Mori K, Li JY, Kalandadze A, Cohen DJ, Devarajan P, Barasch J (2007) Dual action of neutrophil gelatinase-associated lipocalin. J Am Soc Nephrol 18:407–413PubMedCrossRef

18.

Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P (2005) Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 365:1231–1238PubMedCrossRef

19.

Haase-Fielitz A, Bellomo R, Devarajan P, Story D, Matalanis G, Dragun D, Haase M (2009) Novel and conventional serum biomarkers predicting acute kidney injury in adult cardiac surgery–a prospective cohort study. Crit Care Med 37:553–560PubMedCrossRef

20.

Wagener G, Jan M, Kim M, Mori K, Barasch JM, Sladen RN, Lee HT (2006) Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 105:485–491PubMedCrossRef

21.

Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Dobrzycki S (2006) Neutrophil-gelatinase-associated lipocalin and renal function after percutaneous coronary interventions. Am J Nephrol 26:287–292PubMedCrossRef

22.

Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Dobrzycki S (2007) Neutrophil gelatinase-associated lipocalin (NGAL) correlations with cystatin C, serum creatinine and eGFR in patients with normal serum creatinine undergoing coronary angiography. Nephrol Dial Transplant 22:295–296PubMedCrossRef

23.

Bachorzewska-Gajewska H, Malyszko J, Sitniewska E, Malyszko JS, Poniatowski B, Pawlak K, Dobrzycki S (2008) NGAL (neutrophil gelatinase-associated lipocalin) and cystatin C: are they good predictors of contrast nephropathy after percutaneous coronary interventions in patients with stable angina and normal serum creatinine? Int J Cardiol 127:290–291PubMedCrossRef

24.

Ling W, Zhaohui N, Ben H, Leyi G, Jianping L, Huili D, Jiaqi Q (2008) Urinary IL-18 and NGAL as early predictive biomarkers in contrast-induced nephropathy after coronary angiography. Nephron Clin Pract 108:c176–c181PubMedCrossRef

25.

Malyszko J, Bachorzewska-Gajewska H, Poniatowski B, Malyszko JS, Dobrzycki S (2009) Urinary and serum biomarkers after cardiac catheterization in diabetic patients with stable angina and without severe chronic kidney disease. Ren Fail 31:910–919PubMedCrossRef

26.

Nickolas TL, O’Rourke MJ, Yang J, Sise ME, Canetta PA, Barasch N, Buchen C, Khan F, Mori K, Giglio J, Devarajan P, Barasch J (2008) Sensitivity and specificity of a single emergency department measurement of urinary neutrophil gelatinase-associated lipocalin for diagnosing acute kidney injury. Ann Intern Med 148:810–819PubMed

27.

Zappitelli M, Washburn KK, Arikan AA, Loftis L, Ma Q, Devarajan P, Parikh CR, Goldstein SL (2007) Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Critical Care (London, England) 11:R84

28.

Wheeler DS, Devarajan P, Ma Q, Harmon K, Monaco M, Cvijanovich N, Wong HR (2008) Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med 36:1297–1303PubMedCrossRef

29.

Constantin JM, Futier E, Perbet S, Roszyk L, Lautrette A, Gillart T, Guerin R, Jabaudon M, Souweine B, Bazin JE, Sapin V (2011) Plasma neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in adult critically ill patients: a prospective study. J Crit Care 25(176):e171–e176

30.

de Geus HR, Bakker J, Lesaffre EM, le Noble JL (2012) Neutrophil gelatinase-associated lipocalin at ICU admission predicts for acute kidney injury in adult patients. Am J Respir Crit Care Med 183:907–914CrossRef

31.

Endre ZH, Pickering JW, Walker RJ, Devarajan P, Edelstein CL, Bonventre JV, Frampton CM, Bennett MR, Ma Q, Sabbisetti VS, Vaidya VS, Walcher AM, Shaw GM, Henderson SJ, Nejat M, Schollum JB, George PM (2011) Improved performance of urinary biomarkers of acute kidney injury in the critically ill by stratification for injury duration and baseline renal function. Kidney Int 79:1119–1130PubMedCrossRef

32.

Martensson J, Bell M, Oldner A, Xu S, Venge P, Martling CR (2011) Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury. Intensive Care Med 36:1333–1340CrossRef

33.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

34.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRef

35.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31:1250–1256PubMedCrossRef

36.

Barrett BJ, Parfrey PS (1994) Prevention of nephrotoxicity induced by radiocontrast agents. N Engl j of med 331:1449–1450CrossRef

37.

Bagshaw SM, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H, D’Amico G, Goldsmith D, Devarajan P, Bellomo R (2011) Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med 36:452–461CrossRef

38.

Cruz DN, de Cal M, Garzotto F, Perazella MA, Lentini P, Corradi V, Piccinni P, Ronco C (2011) Plasma neutrophil gelatinase-associated lipocalin is an early biomarker for acute kidney injury in an adult ICU population. Intensive Care Med 36:444–451CrossRef

39.

Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH, 3rd, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Devarajan P (2007) NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatric nephrology (Berlin, Germany) 22:2089–2095

40.

Davidson C, Stacul F, McCullough PA, Tumlin J, Adam A, Lameire N, Becker CR (2006) Contrast medium use. Am J Cardio. 98:42K–58KCrossRef

41.

Bu DX, Hemdahl AL, Gabrielsen A, Fuxe J, Zhu C, Eriksson P, Yan ZQ (2006) Induction of neutrophil gelatinase-associated lipocalin in vascular injury via activation of nuclear factor-kappaB. Am. Journal of Pathol 169:2245–2253CrossRef

42.

Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A (2009) Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 54:1012–1024PubMedCrossRef

43.

Siew ED, Ware LB, Gebretsadik T, Shintani A, Moons KG, Wickersham N, Bossert F, Ikizler TA (2009) Urine neutrophil gelatinase-associated lipocalin moderately predicts acute kidney injury in critically ill adults. J Am Soc Nephrol 20:1823–1832PubMedCrossRef

Title: Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness
Authors: Xavier Valette
Benoit Savary
Marie Nowoczyn
Cédric Daubin
Véronique Pottier
Nicolas Terzi
Amélie Seguin
Sabine Fradin
Pierre Charbonneau
Jean-Luc Hanouz
Damien du Cheyron
Publication date: 01-05-2013
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-2826-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Accuracy of plasma neutrophil gelatinase-associated lipocalin in the early diagnosis of contrast-induced acute kidney injury in critical illness

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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