The Diagnostic Accuracy of Plasma Neutrophil Gelatinase–Associated Lipocalin in the Prediction of Acute Kidney Injury in Emergency Department Patients With Suspected Sepsis - 20/08/11
, Stephen Trzeciak, MD, MPH b, Judd E. Hollander, MD c, Robert Birkhahn, MD d, Ronny Otero, MD e, Tiffany M. Osborn, MD f, Eugene Moretti, MD, MHSc g, H. Bryant Nguyen, MD h, Kyle Gunnerson, MD i, David Milzman, MD k, David F. Gaieski, MD c, Munish Goyal, MD c, Charles B. Cairns, MD g, Kenneth Kupfer, PhD j, Seok-Won Lee, PhD j, Emanuel P. Rivers, MD, MPH e
Address for correspondence: Nathan I. Shapiro, MD, MPH, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, CC2-W, Boston, MA 02116617-754–2323, fax 617-754-2350Résumé |
Study objective |
We assess the diagnostic accuracy of plasma neutrophil gelatinase–associated lipocalin (NGAL) to predict acute kidney injury in emergency department (ED) patients with suspected sepsis.
Methods |
We conducted a secondary analysis of a prospective observational study of a convenience sample of patients from 10 academic medical center EDs. Inclusion criteria were adult patients aged 18 years or older, with suspected infection or a serum lactate level greater than 2.5 mmol/L; 2 or more systemic inflammatory response syndrome criteria; and a subsequent serum creatinine level obtained within 12 to 72 hours of enrollment. Exclusion criteria were pregnancy, do-not-resuscitate status, cardiac arrest, or dialysis dependency. NGAL was measured in plasma collected at ED presentation. Acute kidney injury was defined as an increase in serum creatinine measurement of greater than 0.5 mg/dL during 72 hours.
Results |
There were 661 patient enrolled, with 24 cases (3.6%) of acute kidney injury that developed within 72 hours after ED presentation. Median plasma NGAL levels were 134 ng/mL (interquartile range 57 to 277 ng/mL) in patients without acute kidney injury and 456 ng/mL (interquartile range 296 to 727 ng/mL) in patients with acute kidney injury. Plasma NGAL concentrations of greater than 150 ng/mL were 96% sensitive (95% confidence interval [CI] 79% to 100%) and 51% (95% CI 47% to 55%) specific for acute kidney injury. In comparison, to achieve equivalent sensitivity with initial serum creatinine level at ED presentation required a cutoff of 0.7 mg/dL and resulted in specificity of 17% (95% CI 14% to 20%).
Conclusion |
In this preliminary investigation, increased plasma NGAL concentrations measured on presentation to the ED in patients with suspected sepsis were associated with the development of acute kidney injury. Our findings support NGAL as a promising new biomarker for acute kidney injury; however, further research is warranted.
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| Supervising editors: Alan E. Jones, MD; Michael L. Callaham, MD |
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| Author contributions: NIS and ST conceived of the secondary analysis and drafted the primary article. All authors worked on data collection, reviewed the article, and had the opportunity to give critical input. NIS takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded by Biosite Diagnostics. Dr. Shapiro has consulted for and received honoraria from Eli Lilly, and received grant support from Abbott Laboratories, Biosite, and Inverness Medical Innovations. Dr. Trzeciak receives research support from Eli Lilly, Biosite, NovaNordisk, the American Heart Association, and the Shock Society. Dr. Hollander has received honoraria and/or consultant fees from Sanofi- Aventis, GlaxoSmithKline, PDL BioPharma, Bristol- Myers Squibb Medical, Genentech, Astra-Zeneca, Baxter, The Medicines Company, Ot suka America, Molecular Insights, Biosite, Scios, Ethicon, and Schering-Plough, as well as grant support from Inverness Medical, Biosite, Siemens, Sanofi-Aventis, and Abbott Laboratories. Drs. Birkhahn, Osborn, Cairns, and Gunnerson have received grant support from Biosite. Dr. Otero is the recipient of research grants. Dr. Nguyen has consulted for and received honoraria from Eli Lilly and Edwards Lifesciences, and received grant support from Edwards Lifesciences and Biosite. Dr. Gaieski has received research grants from Biosite/Inverness Medical. Dr. Goyal has received honoraria from Edwards Lifesciences. Dr. Rivers has received research support from Biosite, Edwards Lifesciences, Hutchinson Technologies and the National Institute of Allergy and Infectious Disease; honoraria from Biosite, Edwards Life- sciences, Elan Pharmaceuticals, Takeda, and Aggenix; and consultant fees from Eli Lilly, Chiron, AstraZeneca, and Ferring Pharmaceuticals. Drs. Moretti, Ngo, and Milzman have not disclosed any potential conflict of interest. |
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| Publication date: Available online April 3, 2010. |
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| Reprints not available from the authors. |
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| Please see page 53 for the Editor's Capsule Summary of this article. |
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| Provide process.asp?qs_id=5693 on this article at the journal's Web site, www.annemergmed.com. |
Vol 56 - N° 1
P. 52 - juillet 2010 Retour au numéro
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