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J Crit Care. 2019 Oct;53:1-7. doi: 10.1016/j.jcrc.2019.05.017. Epub 2019 May 28.

Integration of urinary neutrophil gelatinase-associated lipocalin with serum creatinine delineates acute kidney injury phenotypes in critically ill children.

Author information

1
Cincinnati Children's Hospital Medical Center, Division of Critical Care Medicine, 3333 Burnet Avenue, MLC 2005, Cincinnati, OH 45229, United States of America. Electronic address: natalja.stanski@cchmc.org.
2
University of Washington School of Medicine, Division of Nephrology, Seattle Children's Hospital, Seattle, WA, United States of America. Electronic address: shina.menon@seattlechildrens.org.
3
Cincinnati Children's Hospital Medical Center, Center for Acute Care Nephrology, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH 45229, United States of America. Electronic address: stuart.goldstein@cchmc.org.
4
Children's Healthcare of Atlanta, Division of Critical Care Medicine, United States of America. Electronic address: rajit.basu@choa.org.

Abstract

PURPOSE:

Acute kidney injury (AKI) is prevalent in critically ill patients and associated with poor outcomes. Current AKI diagnostics- changes to serum creatinine (SCr) and urine output- are imprecise. Integration of injury biomarkers with SCr may improve diagnostic precision.

METHODS:

We performed a secondary analysis of a study of critically ill children. Measurements of urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr samples from ICU admission facilitated the creation of four groups for comparison, based on elevation of SCr from baseline and reference NGAL cut-off value: uNGAL-/SCr-, uNGAL+/SCr-, uNGAL-/SCr + and uNGAL+/SCr+. The primary outcome assessed was AKI severity on Day 3.

RESULTS:

178 children were studied. Compared to uNGAL-/SCr-, uNGAL+/SCr- patients had increased risk for all-stage Day 3 AKI (≥ KDIGO stage 1) (OR 3.83, [1.3-11.3], p = .025). Compared to uNGAL-/SCr+, uNGAL+/SCr + patients had increased risk for severe Day 3 AKI (≥ KDIGO stage 2) (OR 12, [1.4-102], p = .018). The only patients to suffer all-stage Day 3 AKI and mortality were uNGAL+ (3.2% uNGAL+/SCr-; 6.5% uNGAL+/SCr+).

CONCLUSIONS:

Unique biomarker combinations on admission are predictive of distinct Day 3 AKI severity phenotypes. These classifications may enable a more personalized approach to the early management of AKI. Expanded study in larger populations is warranted.

KEYWORDS:

Acute kidney injury (AKI); Biomarker; Neutrophil gelatinase-associated lipocalin; Phenotype; Risk stratification

PMID:
31174170
DOI:
10.1016/j.jcrc.2019.05.017

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