The utility of urinary NGAL (neutrophil gelatinase-associated lipocalin) as a prognostic marker for initiating acute hemoperfusion therapy

Abstract

【Background】Acute kidney injury (AKI) is usually determined by the elevation of serum creatinine level, but this is not suitable for therapeutic decision-making and the early diagnosis of AKI. It has been reported that urinary NGAL is useful in the early diagnosis of AKI and it is likely to be a predictor of continuous hemodiafiltration (CHDF) enforcement, but its usefulness is not clear. 【Purpose】To assess the usefulness of urinary NGAL as a marker to predict the enforcement of acute blood purification therapy. 【Methods】Case-control study. A total of 111 patients who were admitted to the ICU of our hospital from August 2011 to June 2012 and whose urinary NGAL was available were enrolled in this study. We compared the urinary NGAL values in the CHDF group (n=34) and the non-CHDF group (n=77). 【Results】Urinary NGAL at admission to the ICU was markedly higher in the CHDF group, 2,880±802 ng/mL, than in the non-CHDF group, 239±124 ng/mL. When the urinary NGAL value was available at admission, the cut-off value was 76 ng/mL. Its sensitivity for CHDF enforcement was 97.1％, but its specificity was 77.9％. When the maximal urinary NGAL value from admission to the 5th hospital day was available, the cut-off value was 500 ng/mL. It showed a strong association with CHDF enforcement. Its sensitivity was 89.6％ and its specificity was 97.1％. 【Conclusion】Urinary NGAL has the potential to help us determine whether to start CHDF or not, as an early diagnostic marker for AKI onset.