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. 2008 Apr;36(4):1297-303.
doi: 10.1097/CCM.0b013e318169245a.

Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock

Derek S Wheeler  1 , Prasad Devarajan, Qing Ma, Kelli Harmon, Marie Monaco, Natalie Cvijanovich, Hector R Wong
Affiliations

Serum neutrophil gelatinase-associated lipocalin (NGAL) as a marker of acute kidney injury in critically ill children with septic shock

Derek S Wheeler et al. Crit Care Med. 2008 Apr.

Abstract

Objective: To validate serum neutrophil gelatinase-associated lipocalin (NGAL) as an early biomarker for acute kidney injury in critically ill children with septic shock.

Design: Observational cohort study.

Setting: Fifteen North American pediatric intensive care units (PICUs).

Patients: A total of 143 critically ill children with systemic inflammatory response syndrome (SIRS) or septic shock and 25 healthy controls.

Interventions: None.

Measurements and main results: Serum NGAL was measured during the first 24 hrs of admission to the PICU. Acute kidney injury was defined as a blood urea nitrogen concentration >100 mg/dL, serum creatinine >2 mg/dL in the absence of preexisting renal disease, or the need for dialysis. There was a significant difference in serum NGAL between healthy children (median 80 ng/mL, interquartile ratio [IQR] 55.5-85.5 ng/mL), critically ill children with SIRS (median 107.5 ng/mL, IQR 89-178.5 ng/mL), and critically ill children with septic shock (median 302 ng/mL, IQR 151-570 ng/mL; p < .001). Acute kidney injury developed in 22 of 143 (15.4%) critically ill children. Serum NGAL was significantly increased in critically ill children with acute kidney injury (median 355 ng/mL, IQR 166-1322 ng/mL) compared with those without acute kidney injury (median 186 ng/mL, IQR 98-365 ng/mL; p = .009).

Conclusions: Serum NGAL is a highly sensitive but nonspecific predictor of acute kidney injury in critically ill children with septic shock. Further validation of serum NGAL as a biomarker of acute kidney injury in this population is warranted.

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Figures

Figure 1
Figure 1. Box and whisker plot of serum NGAL concentrations measured on day 1 of admission to the PICU in 143 critically ill children versus 25 healthy children
The vertical box represents the 25th percentile (bottom line), median (middle line), and 75th percentile (top line) values, while the error bars represent the 10th and 90th percentile values. The dots represent values outside the 10th and 90th percentile, respectively.
Figure 2
Figure 2. Box and whisker plot of serum NGAL concentrations measured on day 1 of admission to the PICU in critically ill children with AKI versus critically ill children without AKI
The vertical box represents the 25th percentile (bottom line), median (middle line), and 75th percentile (top line) values, while the error bars represent the 10th and 90th percentile values. The dots represent values outside the 10th and 90th percentile, respectively.
Figure 3
Figure 3. Box and whisker plot of serum NGAL concentrations measured on day 3 of admission to the PICU in critically ill children with AKI versus critically ill children without AKI
The vertical box represents the 25th percentile (bottom line), median (middle line), and 75th percentile (top line) values, while the error bars represent the 10th and 90th percentile values. The dots represent values outside the 10th and 90th percentile, respectively.
Figure 4
Figure 4
Receiver-operating curve (ROC) analysis of serum NGAL concentrations measured on day 1 of admission to the PICU in critically ill children with AKI versus critically ill children without AKI.
See this image and copyright information in PMC

References

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