Kassem, M., Mohamed, M., Mohammed, A. (2019). Serum Neutrophil Gelatinase-associated Lipocalin in children with septicemia. test, 23(2), 101-110. doi: 10.21608/smj.2019.47649
Mohamed A Kassem; Mostfa Ashry Mohamed; Ahmed N. Mohammed. "Serum Neutrophil Gelatinase-associated Lipocalin in children with septicemia". test, 23, 2, 2019, 101-110. doi: 10.21608/smj.2019.47649
Kassem, M., Mohamed, M., Mohammed, A. (2019). 'Serum Neutrophil Gelatinase-associated Lipocalin in children with septicemia', test, 23(2), pp. 101-110. doi: 10.21608/smj.2019.47649
Kassem, M., Mohamed, M., Mohammed, A. Serum Neutrophil Gelatinase-associated Lipocalin in children with septicemia. test, 2019; 23(2): 101-110. doi: 10.21608/smj.2019.47649

Serum Neutrophil Gelatinase-associated Lipocalin in children with septicemia

Sohag Medical Journal
Article 22, Volume 23, Issue 2, April 2019, Pages 101-110    PDF (373.01 K)
Document Type: Original Article
DOI: 10.21608/smj.2019.47649
Authors
Mohamed A Kassem1; Mostfa Ashry Mohamed2; Ahmed N. Mohammed3
1Department of Pediatrics, Faculty of Medicine,Sohag University,Sohag, Egypt.
2Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt.
3Department of Clinical Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt.
Abstract
Neutrophil gelatinase-associated lipocalin (NGAL) is a rapidly emerging biomarker for early detection of acute kidney injury (AKI). The aim of the study is to evaluate the impact of sepsis on serum NGAL in critically ill children and to investigate whether the presence of sepsis affects the ability of serum NGAL to predict AKI. Sixty-eight patients, who met criteria of sepsis and related syndromes, were classified into two groups (septic shock and severe sepsis). They were reclassified regarding who developed AKI into AKI and non- AKI groups. Twenty sex and age-matched healthy subjects served as a control group. Serum NGAL was assayed using Enzyme-linked Immunosorbent Assay (ELISA), and serum creatinine was measured using the kinetic spectrophotometric method. Serum NGAL levels were significantly high in critically ill septic patients compared to healthy controls (median: 100.4ng/ml vs. 47.1 ng/ml, P>0.0001), and were significantly higher in septic shock (median 105.1ng/ml) than in severe sepsis (median 96ng/ml) with P values of 0.005. However, there was no significant difference in the levels of serum NGAL between AKI patients and non- AKI patients (P=0.3). Receiver operating characteristic (ROC) curve analysis of serum NGAL for prediction of AKI in critically ill septic children showed an area under the curve (AUC) was 0.56 (95% C.I. =0.42-0.70) with an optimal cutoff value of 102.5ng/ml, sensitivity=56.2%, specificity 55.6%, PPV =52.9%, NPV =58.8%, and accuracy=55.9%. For serum creatinine, the AUC was 0.97 (95% C.I. =0.94- 1.00) with an optimal cutoff value of 0.6 mg/dl, sensitivity= 90.6%, specificity 91.7%, PPV=90.6%, NPV=91.7% and accuracy=91.2%. In conclusion, serum NGAL is raised in critically ill septic children and is a marker of bacterial infection and systemic inflammation. However, in AKI associated with sepsis, serum NGAL is not a specific biomarker for the prediction of AKI and it loses its early predictive property. In such patients, serum creatinine is more specific than serum NGAL.
Keywords
Neutrophil gelatinase-associated lipocalin; Acute kidney injury; creatinine; Sepsis
Supplementary Files
References
  1. Acute Kidney Injury Work Group. Kidney Disease Improving Global Outcomes (KDIGO) - Clinical Practice Guideline for Acute Kidney Injury. Kidney Inter. 2012;2:1-138.
  2. Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, Phan V, Zappitelli M. Acute kidney injury is an independent risk factor for pediatric intensive care unit mortality, the longer length of stay and prolonged mechanical ventilation in critically ill children: a two-center retrospective cohort study. Crit Care. 2011; 15: R146.
  3. Bagshaw SM, Bennett M, Haase M, Haase-Fielitz A, Egi M, Morimatsu H, d'Amico G, Goldsmith D, Devarajan P, Bellomo R: Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness. Intensive Care Med 2010;36:452-461.
  4. Bagshaw, S.M., S. Uchino, R. Bellomo, H. Morimatsu, S. Morgera, et al. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol.2007, 2: 431-439.
  5. Consuelo Restrepo de Rovetto, Julián Andrés Mora, Sergio Alexandre Cardona, Andrés Felipe Marmolejo, Juan Fernando Paz, Iris de Castaño. Acute kidney injury applying pRifle scale in Children of Hospital Universitario del Valle in Cali, Colombia: clinical features, management, and evolution. Colombia Medica.2012; Vol 43, No 3.
  6. Devarajan P. Biomarkers for the early detection of acute kidney injury. Curr Opin Pediatr. 2011;23(2):194–200.
  7. Goldstein, B., B. Giroir, A. Randolph. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med.2005; 6(1): 2-8.
  8. Hanley, J.A., B.A. McNeil. The meaning and use of the area under a receiver operating (ROC) curve. Radiology.1982; 143: 29-36.
  9. Kawasaki Tatsuya. Update on pediatric sepsis: a review. Journal of Intensive Care 2017; 5:47.
  10. Kim H, Hur M, Cruz DN, Moon HW, Yun YM: Plasma neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis. Clin Biochem 2013;46:1414-1418.
  11. Kjeldsen, L., J.B. Cowland, N. Borregaard. Human neutrophil gelatinase-associated lipocalin and homologous proteins in rat and mouse. Biochim Biophys Acta.2000; 1482(1-2): 272-283.
  12. Krishnamurthy S. Incidence and etiology of acute kidney injury in Southern India: author’s reply. Indian J Pediatr. 2013; 80: 797.
  13. Martensson, J., B. Max, O. Anders, X. Shengyuan, et al. Neutrophil gelatinase-associated lipocalin in adult septic patients with and without acute kidney injury.Intensive Care Med.2010; 36(8): 1333-1340.
  14. Mazzachi, B.C., M.J. Peake, V. Ehrhardt. Reference range and method comparison studies for enzymatic and Jaffe´ creatinine assay in plasma and serum and early morning urine.Clin Lab.2000; 46: 53-55.
  15. Mori, K., H.T. Lee, D. Rapoport, I.R. Drexler, et al. Endocytic delivery of lipocalin siderophore-iron complex rescues the kidney from ischemia-reperfusion injury. J Clin Invest. 2005; 115: 610-621.
  16. Mori, K., K. Nakao. Neutrophil gelatinase-associated lipocalin as the real-time indicator of active kidney damage. Kidney Int.2007; 71(10): 967-70.
  17. Pollack, M.M., K.M. Patel, U.E. Ruttimann. PRISM III: an updated Pediatric Risk of Mortality score.Crit Care Med.1996; 24(5): 743-752.
  18. Shalaby Mohamed, Norah Khathlan, Osama Safder, Fatina Fadel, Youssef M.K. Farag, Ajay K. Singh, and Jameela A. Kari. The outcome of acute kidney injury in pediatric patients admitted to the intensive care unit. Clinical Nephrology2014, Vol. 82 – No. 6 (379-386).
  19. Singer Eugenia, Lajos Markó, Neal Paragas, Jonathan Barasch, Duska Dragun, Dominik N. Müller, Klemens Budde, and Kai M. Schmidt-Ott. Neutrophil gelatinase-associated lipocalin: pathophysiology and clinical applications. Acta Physiol (Oxf). 2013 Apr; 207(4): 663–672.
  20. Wagener, G., M. Jan, M. Kim, K. Mori, J.M. Barasch, et al. Association between increases in urinary neutrophil gelatinase-associated lipocalin and acute renal dysfunction after adult cardiac surgery. Anesthesiology 2006; 105: 485-491.
  21. Waikar S, Betensky R, Bonventre J: Creatinine as the gold standard for kidney injury biomarker studies? Nephrol Dial Transplant 2009, 24:3265-3268.
  22. Wheeler, D.S., P. Devarajan, Q. Ma, K. Harmon, et al. Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock. Crit Care Med.2008; 36: 1297-1303.
  23. Zappitelli, M., K.K. Washburn, A.A. Arikan, L. Loftis, et al. Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study. Crit Care.2007; 11: R84.
 

 

 

 

 

 

 

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