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  • Haase, Michael (author)

The Outcome of Neutrophil Gelatinase-Associated Lipocalin-Positive Subclinical Acute Kidney Injury A Multicenter Pooled Analysis of Prospective Studies

  • Article/chapterEnglish2011

Publisher, publication year, extent ...

  • Elsevier BV,2011
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-153572
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-153572URI
  • https://doi.org/10.1016/j.jacc.2010.11.051DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:122483010URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Objectives The aim of this study was to test the hypothesis that, without diagnostic changes in serum creatinine, increased neutrophil gelatinase-associated lipocalin (NGAL) levels identify patients with subclinical acute kidney injury (AKI) and therefore worse prognosis. Background Neutrophil gelatinase-associated lipocalin detects subclinical AKI hours to days before increases in serum creatinine indicate manifest loss of renal function. Methods We analyzed pooled data from 2,322 critically ill patients with predominantly cardiorenal syndrome from 10 prospective observational studies of NGAL. We used the terms NGAL(-) or NGAL(+) according to study-specific NGAL cutoff for optimal AKI prediction and the terms sCREA(-) or sCREA(+) according to consensus diagnostic increases in serum creatinine defining AKI. A priori-defined outcomes included need for renal replacement therapy (primary endpoint), hospital mortality, their combination, and duration of stay in intensive care and in-hospital. Results Of study patients, 1,296 (55.8%) were NGAL(-)/sCREA(-), 445 (19.2%) were NGAL(+)/sCREA(-), 107 (4.6%) were NGAL(-)/sCREA(+), and 474 (20.4%) were NGAL(+)/sCREA(+). According to the 4 study groups, there was a stepwise increase in subsequent renal replacement therapy initiation-NGAL(-)/sCREA(-): 0.0015% versus NGAL(+)/sCREA(-): 2.5% (odds ratio: 16.4, 95% confidence interval: 3.6 to 76.9, p < 0.001), NGAL(-)/sCREA(+): 7.5%, and NGAL(+)/sCREA(+): 8.0%, respectively, hospital mortality (4.8%, 12.4%, 8.4%, 14.7%, respectively) and their combination (4-group comparisons: all p < 0.001). There was a similar and consistent progressive increase in median number of intensive care and in-hospital days with increasing biomarker positivity: NGAL(-)/sCREA(-): 4.2 and 8.8 days; NGAL(+)/sCREA(-): 7.1 and 17.0 days; NGAL(-)/sCREA(+): 6.5 and 17.8 days; NGAL(+)/sCREA(+): 9.0 and 21.9 days; 4-group comparisons: p = 0.003 and p = 0.040, respectively. Urine and plasma NGAL indicated a similar outcome pattern. Conclusions In the absence of diagnostic increases in serum creatinine, NGAL detects patients with likely subclinical AKI who have an increased risk of adverse outcomes. The concept and definition of AKI might need re-assessment.

Subject headings and genre

  • acute kidney injury (AKI)
  • biomarker
  • creatinine
  • mortality
  • neutrophil gelatinase-associated lipocalin (NGAL)
  • renal replacement therapy (RRT)
  • MEDICINE
  • MEDICIN

Added entries (persons, corporate bodies, meetings, titles ...)

  • Devarajan, Prasad (author)
  • Haase-Fielitz, Anja (author)
  • Bellomo, Rinaldo (author)
  • Cruz, Dinna N. (author)
  • Wagener, Gebhard (author)
  • Krawczeski, Catherine D. (author)
  • Koyner, Jay L. (author)
  • Murray, Patrick (author)
  • Zappitelli, Michael (author)
  • Goldstein, Stuart L. (author)
  • Makris, Konstantinos (author)
  • Ronco, ClaudioKarolinska Institutet (author)
  • Mårtensson, JohanKarolinska Institutet (author)
  • Martling, Claes-RolandUppsala universitet,Klinisk kemi (author)
  • Venge, PerUppsala universitet,Klinisk kemi(Swepub:uu)pervenge (author)
  • Siew, EdwardUppsala universitet,Klinisk kemi (author)
  • Ware, Lorraine B. (author)
  • Ikizler, T. Alp (author)
  • Mertens, Peter R. (author)
  • Karolinska InstitutetKlinisk kemi (creator_code:org_t)

Related titles

  • In:Journal of the American College of Cardiology: Elsevier BV57:17, s. 1752-17610735-10971558-3597

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