Introduction: Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker in diagnosis and prognosis in kidney and cardiovascular disease. However, the relationship between NGAL concentration and ischemic stroke is poorly understood.
Hypothesis: We investigated plasma NGAL concentration in patients with acute ischemic stroke in relation to medical history, risk factors, hematologic and biochemical tests, stroke severity and subtype.
Methods: Clinical data of 139 patients who admitted to a tertiary hospital with TIA (n=17) and ischemic stroke (n=122) were collected. We evaluated the following parameters: A) Medical history and risk factors of the patients; B) Hematologic and biochemical blood test at the time of admission; C) Stroke severity which was assessed using the National Institutes of Health Stroke Scale (NIHSS); D) Stroke subtype which was decided by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.
Results: In our study (62% male, mean age 65 ± 14 years), median admission serum NGAL level was 75 ng/mL (interquartile range [IQR] 52-112 ng/mL). Serum NGAL level was elevated in 21 (15.1%) patients with the cutoff point of 150 ng/mL. High plasma NGAL concentrations were associated with age (p = 0.018) and previous history of coronary artery occlusive disease (p = 0.003). Mean NIHSS score in high NGAL group was higher than normal NGAL group (7.6 ±7.2 vs 4.4 ± 5.6, p = 0.021). We observed significant correlations between serum NGAL with C-reactive protein (spearman coefficient rho = 0.319, p < 0.001), erythrocyte sedimentation rate (r = 0.410, p < 0.001), creatinine (r = 0.237, p = 0.005), blood urea nitrogen (r = 0.353, p = 0.003), estimated glomerular filtration rate (r = -0.471, p < 0.001), fibrinogen (r = 0.327, p < 0.001) and homocysteine (r = 0.189, p = 0.032). There were no significant differences in mean serum NGAL level between TIA patients and stroke patients, and stroke subtypes by TOAST classification.
Conclusions: Increased NGAL in acute ischemic stroke patients is associated with age, previous coronary artery occlusive disease history and stroke severity. Elevated plasma levels of NGAL appear to be correlated with some biomarkers associated with inflammation, coagulation and kidney dysfunction.