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Observational Study
. 2019 May 24;20(1):186.
doi: 10.1186/s12882-019-1381-3.

Impact of blood glucose levels on the accuracy of urinary N-acety-β-D-glucosaminidase for acute kidney injury detection in critically ill adults: a multicenter, prospective, observational study

Lin Wang  1 , Yujun Deng  2 , Yiling Zhai  2 , Feng Xu  3 , Jinghua Li  4 , Danqing Zhang  2 , Lu Gao  2 , Yating Hou  2 , Xin OuYang  2 , Linhui Hu  2 , Jie Yuan  2 , Heng Ye  5 , Ruibin Chi  6 , Chunbo Chen  7
Affiliations
Observational Study

Impact of blood glucose levels on the accuracy of urinary N-acety-β-D-glucosaminidase for acute kidney injury detection in critically ill adults: a multicenter, prospective, observational study

Lin Wang et al. BMC Nephrol. .

Abstract

Background: The performance of urinary N-acetyl-β-D-glucosaminidase (uNAG) for the detection of acute kidney injury (AKI) was controversial. uNAG is positively correlated with blood glucose levels. Hyperglycemia is common in the critically ill adults. The influence of blood glucose levels on the accuracy of uNAG in AKI detection has not yet been reported. The present study evaluated the effect of blood glucose levels on the diagnostic accuracy of uNAG to detect AKI.

Methods: A total of 1585 critically ill adults in intensive care units at three university hospitals were recruited in this prospective observational study. uNAG, serum glucose, and glycosylated hemoglobin (HbA1c) were measured at ICU admission. Patients were categorized based on the history of diabetes and blood glucose levels. The performance of uNAG to detect AKI in different groups was assessed by the area under the receiver operator characteristic curve.

Results: Four hundred and twelve patients developed AKI, of which 109 patients were severe AKI. uNAG was significantly correlated with the levels of serum glucose (P < 0.001) and HbA1c (P < 0.001). After stratification based on the serum glucose levels, no significant difference was observed in the AUC of uNAG in detecting AKI between any two groups (P > 0.05). Stratification for stress hyperglycemic demonstrated similar results.However, among non-diabetic patients, the optimal cut-off value of uNAG for detecting AKI was higher in stress hyperglycemic patients as compared to those without stress hyperglycemia.

Conclusions: The blood glucose levels did not significantly affect the performance of uNAG for AKI detection in critically ill adults. However, the optimal cut-off value of uNAG to detect AKIwas affected by stress hyperglycemia in non-diabetic patients.

Keywords: Acute kidney injury; Blood glucose levels; Critically ill patients; N-acetyl-β-D-glucosaminidase.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow-chart of the critically ill patients. ESRD, End-stage renal disease; RRT, Renal replacement therapy; ICU, Intensive care unit; AKI, Acute kidney injury
Fig. 2
Fig. 2
ROC analysis for the ability of uNAG to detect total AKI. AKI, acute kidney injury; uNAG, urinary N-acetyl-glucosaminidase; AUC, area under the receiver operating characteristic curve; 95% CI, 95% confidence interval
See this image and copyright information in PMC

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