Urinary NGAL-Positive Acute Kidney Injury and Poor Long-term Outcomes in Hospitalized Patients

Neutrophil gelatinase-associated lipocalin (NGAL) is a widely studied biomarker of renal tubular injury. Urinary NGAL (uNGAL) during acute kidney injury (AKI) predicts short-term adverse outcomes. However, the long-term predictive value is unknown. We performed a prospective observational study of 1...

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Bibliographic Details
Published in:	Kidney international reports Vol. 1; no. 3; pp. 114 - 124
Main Authors:	Singer, Eugenia, Schrezenmeier, Eva V, Elger, Antje, Seelow, Evelyn R, Krannich, Alexander, Luft, Friedrich C, Schmidt-Ott, Kai M
Format:	Journal Article
Language:	English
Published:	United States Elsevier 01-09-2016
Subjects:	acute kidney injury Clinical Research long-term outcomes neutrophil gelatinase–associated lipocalin (NGAL) long-term outcomes neutrophil gelatinase–associated lipocalin (NGAL) acute kidney injury
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Summary:	Neutrophil gelatinase-associated lipocalin (NGAL) is a widely studied biomarker of renal tubular injury. Urinary NGAL (uNGAL) during acute kidney injury (AKI) predicts short-term adverse outcomes. However, the long-term predictive value is unknown. We performed a prospective observational study of 145 patients with hospital-acquired AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria and analyzed the long-term predictive value of uNGAL at the time of AKI. We defined a composite outcome of all-cause mortality and the development of end-stage renal disease (ESRD). In all, 61 AKI patients died and 22 developed ESRD within 6 months. The uNGAL levels were significantly higher in patients with poor long-term outcomes. uNGAL levels ≥362 μg/l (highest quartile) and uNGAL levels between 95 and 362 μg/l (third quartile) were associated with hazard ratios of 3.7 (95% confidence interval, 2.1-6.5) and 1.9 (1.1-3.5), respectively, compared with uNGAL levels <95 μg/l (lower quartiles). After 6 months, 67% and 43% of patients within the highest and third uNGAL quartile, respectively, had either progressed to ESRD or died, compared to only 21% of patients with uNGAL in the lower 2 quartiles ( < 0.001). In multivariable Cox regression analyses accounting for conventional predictors, uNGAL was the strongest independent predictor of adverse long-term outcomes. The association of uNGAL levels and poor long-term outcomes remained significant in the subgroup of 107 AKI survivors discharged without requiring dialysis ( = 0.002). These data indicate that elevated uNGAL levels at AKI diagnosis predict poor long-term outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2468-0249 2468-0249
DOI:	10.1016/j.ekir.2016.07.003