Mortality prediction of serum neutrophil gelatinase-associated lipocalin in patients requiring continuous renal replacement therapy
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: We investigated whether serum neutrophil gelatinase-associated lipocalin (NGAL) can predict mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: This study enrolled 169 patients who underwent serum NGAL testing at CRRT initiation from June 2017 to January 2019. The predictive power of serum NGAL level for 28-day mortality was compared to the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score and Sequential Organ Failure Assessment (SOFA) score via area under the receiver operating characteristic curve (AuROC) value. Results: There were 55 survivors and 114 non-survivors at 28 days post-CRRT initiation. Median serum NGAL level was significantly higher in the non-survivor group than in the survivor group (743.0 ng/mL vs. 504.0 ng/mL, p = 0.003). The AuROC value of serum NGAL level was 0.640, which was lower than APACHEII score and SOFA score values (0.767 and 0.715, respectively). However, in the low APACHE-II score group (< 27.5), AuROC value of serum NGAL was significantly increased (0.698), and it was an independent risk factor for 28 day-mortality (hazard ratio, 2.405; 95% confidence interval, 1.209 to 4.783; p = 0.012). Conclusions: In patients with AKI requiring CRRT, serum NGAL levels may be useful for predicting short-term mortality in those with low APACHE-II scores.
Abstract
Background/Aims: We investigated whether serum neutrophil gelatinase-associated lipocalin (NGAL) can predict mortality in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Methods: This study enrolled 169 patients who underwent serum NGAL testing at CRRT initiation from June 2017 to January 2019. The predictive power of serum NGAL level for 28-day mortality was compared to the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) score and Sequential Organ Failure Assessment (SOFA) score via area under the receiver operating characteristic curve (AuROC) value. Results: There were 55 survivors and 114 non-survivors at 28 days post-CRRT initiation. Median serum NGAL level was significantly higher in the non-survivor group than in the survivor group (743.0 ng/mL vs. 504.0 ng/mL, p = 0.003). The AuROC value of serum NGAL level was 0.640, which was lower than APACHEII score and SOFA score values (0.767 and 0.715, respectively). However, in the low APACHE-II score group (< 27.5), AuROC value of serum NGAL was significantly increased (0.698), and it was an independent risk factor for 28 day-mortality (hazard ratio, 2.405; 95% confidence interval, 1.209 to 4.783; p = 0.012). Conclusions: In patients with AKI requiring CRRT, serum NGAL levels may be useful for predicting short-term mortality in those with low APACHE-II scores.
참고문헌 (31)
- Kjeldsen L, "Isolation and primary structure of NGAL, a novel protein associated with human neutrophil gelatinase", J Biol Chem, 268, pp.10425~10432 (1993)
- Ronco C, "Neutrophil gelatinase-associated lipocalin : ready for routine clinical use? An international perspective", Blood Purif, 37, pp.271~285 (2014)
- Lippi G, "Neutrophil gelatinase-associated lipocalin in cancer", Adv Clin Chem, 64, pp.179~219 (2014)
- Paragas N, "The Ngal reporter mouse detects the response of the kidney to injury in real time", Nat Med, 17, pp.216~222 (2011)
- Otto GP, "Plasma neutrophil gelatinase-associated lipocalin is primarily related to inflammation during sepsis : a translational approach", PLoS One, 10, pp.e0124429~ (2015)
- Cantaluppi V, "Plasma NGAL is an early biomarker of graft function, calcineurin inhibitor nephrotoxicity and tubular regeneration in kidney transplantation from extended criteria donors: 902", Transplantation, 94(10 Suppl), pp.1168~ (2012)
- Cruz DN, "Neutrophil gelatinase-associated lipocalin as a biomarker of cardiovascular disease : a systematic review", Clin Chem Lab Med, 50, pp.1533~1545 (2012)
- Alvelos M, "Prognostic value of neutrophil gelatinase-associated lipocalin in acute heart failure", Int J Cardiol, 165, pp.51~55 (2013)
- Hemdahl AL, "Expression of neutrophil gelatinase-associated lipocalin in atherosclerosis and myocardial infarction", Arterioscler Thromb Vasc Biol, 26, pp.136~142 (2006)
- Lee CW, "A combination of SOFA score and biomarkers gives a better prediction of septic AKI and in-hospital mortality in critically ill surgical patients : a pilot study", World J Emerg Surg, 13, pp.41~ (2018)
- Chang W, "Predictive utilities of neutrophil gelatinase-associated lipocalin(NGAL)in severe sepsis", Clin Chim Acta, 481, pp.200~206 (2018)
- Wang B, "Increased neutrophil gelatinase-associated lipocalin is associated with mortality and multiple organ dysfunction syndrome in severe sepsis and septic shock", Shock, 44, pp.234~238 (2015)
- Mahmoodpoor A, "Urinary versus plasma neutrophil gelatinase-associated lipocalin(NGAL)as a predictor of mortality for acute kidney injury in intensive care unit patients", J Clin Anesth, 44, pp.12~17 (2018)
- Kellum JA, "Kidney disease : improving global outcomes(KDIGO)acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury", Kidney Int Suppl, 2, pp.1~138 (2012)
- Knaus WA, "APACHE II : a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
- Vincent JL, "The SOFA(Sepsis-related Organ Failure Assessment)score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Seo Y, "Peformance evaluation of bioporto diagnostics’ neutrophil gelatinase-associated lipocalin assay on automated clinical chemistry analyzer Hitachi 7600", J Lab Med Qual Assur, 35, pp.23~28 (2013)
- Krzanowski WJ, "ROC Curves for Continuous Data" (2009), CRC Press
- Chiavone PA, "Evaluation of APACHE II system among intensive care patients at a teaching hospital", Sao Paulo Med J, 121, pp.53~57 (2003)
- Naved SA, "APACHE-II score correlation with mortality and length of stay in an intensive care unit", J Coll Physicians Surg Pak, 21, pp.4~8 (2011)
- Kumpers P, "Serum neutrophil gelatinase-associated lipocalin at inception of renal replacement therapy predicts survival in critically ill patients with acute kidney injury", Crit Care, 14, pp.R9~ (2010)
- Marsh HM, "Assessment of prediction of mortality by using the APACHE II scoring system in intensive-care units", Mayo Clin Proc, 65, pp.1549~1557 (1990)
- Mishra J, "Neutrophil gelatinase-associated lipocalin(NGAL)as a biomarker for acute renal injury after cardiac surgery", Lancet, 365, pp.1231~1238 (2005)
- Tajima S, "Clinical prospects of biomarkers for the early detection and", or prediction of organ injury associated with pharmacotherapy, 2019, pp.170, 113664~
- Borkham-Kamphorst E, "Induction of lipocalin-2 expression in acute and chronic experimental liver injury moderated by pro-inflammatory cytokines interleukin-1β through nuclear factor-κB activation", Liver Int, 31, pp.656~665 (2011)
- Eilenberg W, "Neutrophil gelatinase-associated lipocalin(NGAL)is associated with symptomatic carotid atherosclerosis and drives pro-inflammatory state in vitro", Eur J Vasc Endovasc Surg, 51, pp.623~631 (2016)
- Latouche C, "Neutrophil gelatinase-associated lipocalin is a novel mineralocorticoid target in the cardiovascular system", Hypertension, 59, pp.966~972 (2012)
- Hamzic N, "Immune-induced expression of lipocalin-2 in brain endothelial cells : relationship with interleukin-6, cyclooxygenase-2 and the febrile response", J Neuroendocrinol, 25, pp.271~280 (2013)
- Naude PJ, "Neutrophil gelatinase-associated lipocalin : a novel inflammatory marker associated with late-life depression", J Psychosom Res, 75, pp.444~450 (2013)
- Flo TH, "Lipocalin 2 mediates an innate immune response to bacterial infection by sequestrating iron", Nature, 432, pp.917~921 (2004)
- Bu DX, "Induction of neutrophil gelatinase-associated lipocalin in vascular injury via activation of nuclear factor-kappaB", Am J Pathol, 169, pp.2245~2253 (2006)