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Critical Care Research and Practice
Volume 2012, Article ID 712695, 8 pages
http://dx.doi.org/10.1155/2012/712695
Clinical Study

Systemic and Urinary Neutrophil Gelatinase-Associated Lipocalins Are Poor Predictors of Acute Kidney Injury in Unselected Critically Ill Patients

1Department of Intensive Care Medicine, Tergooi Hospitals, Location Blaricum, 1261 AN Blaricum, The Netherlands
2Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
3Laboratory for Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
4Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
5Department of Intensive Care Medicine, Scheper Ziekenhuis Emmen, 7824 AA Emmen, The Netherlands
6Department of Intensive Care Medicine, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
7HERMES Critical Care Group, 1105 AZ Amsterdam, The Netherlands
8Department of Intensive Care Medicine, Gelre Hospitals, Location Lucas, 7334 DZ Apeldoorn, The Netherlands

Received 11 June 2012; Accepted 19 September 2012

Academic Editor: Manuel E. Herrera-Gutiérrez

Copyright © 2012 Annick A. Royakkers et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Neutrophil gelatinase-associated lipocalin (NGAL) in serum and urine have been suggested as potential early predictive biological markers of acute kidney injury (AKI) in selected critically ill patients. Methods. We performed a secondary analysis of a multicenter prospective observational cohort study of unselected critically ill patients. Results. The analysis included 140 patients, including 57 patients who did not develop AKI, 31 patients who developed AKI, and 52 patients with AKI on admission to the ICU. Levels of sNGAL and uNGAL on non-AKI days were significantly lower compared to levels of sNGAL on RIFLERISK days, RIFLEINJURY days, and RIFLEFAILURE days. The AUC of sNGAL for predicting AKI was low: 0.45 (95% confidence interval (CI) 0.27–0.63) and 0.53 (CI 0.38–0.67), 2 days and 1 day before development of AKI, respectively. The AUC of uNGAL for predicting AKI was also low: 0.48 (CI 0.33–0.62) and 0.48 (CI 0.33–0.62), 2 days and 1 day before development of AKI, respectively. AUC of sNGAL and uNGAL for the prediction of renal replacement therapy requirement was 0.47 (CI 0.37–0.58) and 0.26 (CI 0.03–0.50). Conclusions. In unselected critically ill patients, sNGAL and uNGAL are poor predictors of AKI or RRT.