Plasma Neutrophil Gelatinase‐Associated Lipocalin diagnosed acute kidney injury in patients with systemic inflammatory disease and sepsis

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Typically, 30% to 60% of patients admitted to the intensive care unit (ICU) develop acute kidney injury (AKI).1 Within our local ICU, 65% of patients have AKI.3 The demonstration that AKI is an independent risk factor for mortality,3 has led to a new understanding that patients may die due to AKI, not only with AKI.4 Furthermore, AKI leads to increased hospital readmission rates and development of CKD.5 The high incidence of AKI in our population may be attributed to sepsis.3 Sepsis is the leading cause of ICU admission,6 and septic AKI is associated with higher severity of illness and an increased mortality rate.7
Current consensus definitions of AKI are based on surrogates of filtration, namely a change in plasma creatinine or urine output.8 Waiting to discover if creatinine increases delays diagnosis, and low urine output is not very specific.9 Injury biomarkers offer the prospect of early detection of AKI as well as informing the clinician of the severity of damage to the kidney.10 To date, plasma Neutrophil Gelatinase Associated‐Lipocalin (NGAL) is one of the most promising biomarkers for AKI detection; however, it is also known to be increased by inflammation and infection, which may limit its use.11
Several studies have investigated the utility of NGAL to diagnose AKI in sepsis patients with conflicting results.13 These studies were conducted in Western countries, and to the best of our knowledge no study has been done in our region. In addition, many studies have only assessed NGAL's ability to diagnose AKI and whether it also predicts hard outcomes such as mortality.17
We aimed to evaluate the utility of plasma NGAL in the presence of inflammation and infection to detect AKI, and to determine if a different diagnostic threshold was appropriate in the presence of sepsis or inflammation. In addition, we evaluated the performance of NGAL for diagnosis of sepsis and prediction of mortality.

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