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NDT Advance Access published online on May 27, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp234
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The predictive performance of plasma neutrophil gelatinase-associated lipocalin (NGAL) increases with grade of acute kidney injury

Anja Haase-Fielitz1,2, Rinaldo Bellomo1, Prasad Devarajan3, Michael Bennett3, David Story4, George Matalanis5, Ulrich Frei2, Duska Dragun2 and Michael Haase1,2

1 Department of Intensive Care, Austin Health, Melbourne, Australia 2 Department of Nephrology and Intensive Care Medicine, Charité University Medicine, Berlin, Germany 3 Department of Pediatrics and Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA 4 Department of Anaesthesiology 5 Department of Cardiac Surgery, Austin Health, Melbourne, Australia

Correspondence and offprint requests to: Rinaldo Bellomo; E-mail: rinaldo.bellomo{at}austin.org.au



  Abstract

Background. In adult cardiac surgery, the predictive value for AKI of neutrophil gelatinase-associated lipocalin (NGAL) appears to have wide variability. The choice of definition of acute kidney injury (AKI) might, at least in part, account for such variability.

Methods. In a prospective study of 100 adult cardiac surgery patients, we assessed the value of postoperative plasma NGAL in predicting AKI according to the degree of severity used for its definition.

Results. The predictive value of plasma NGAL varied according to the AKI definition used and was higher for more severe AKI (increase in creatinine >50%: mean AUC–ROC 0.79 ± 0.01) compared to less severe AKI (>25%: mean AUC–ROC 0.65 ± 0.02); P = 0.001. The discriminatory ability of NGAL for AKI also increased with increasing RIFLE classes (AUC–ROC R: 0.72, I: 0.79, F: 0.80) or AKIN stages (AUC–ROC 1: 0.75, 2: 0.78, 3: 0.81); P = 0.015. It was highest for the prediction of renal replacement therapy (AUC–ROC: 0.83).

Conclusions. In adult cardiac surgery patients, the predictive value of NGAL increases with grade of AKI. This observation needs to be taken into account when interpreting any future studies of this biomarker.

Keywords: acute kidney injury; cardiac surgery; neutrophil gelatinase-associated lipocalin (NGAL); RIFLE; grade

Received for publication: 12. 3.09
Accepted in revised form: 28. 4.09


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