Effect of urinary NGAL on the timing of renal replacement therapy in patients with acute renal injury associated with sepsis / 解放军医学杂志

ABSTRACT

Objective To investigate the effect of urinary neutrophil gelatinase-associated lipocalin (uNGAL) on the timing of continuous renal replacement therapy (CRRT) in patients with acute renal injury (AKI) associated with sepsis. Methods One hundred patients with sepsis admitted to Shanxi Grand Hospital from January 2013 to June 2017 were selected as research objects. Sixty patients with uNGAL greater than 1310 ng/ml were defined as high uNGAL group, and 40 patients with uNGAL smaller than 1310 ng/ml were defined as low uNGAL group. The high uNGAL group was randomly assigned to the early CRRT group or standard treatment group. The clinical outcomes were compared between the high uNGAL group and the low uNGAL group. Changes in the levels of uNGAL, TNF-α and IL-6 inflammatory factors at different time points before and after treatment in the early CRRT group and the standard treatment group. Results The 28 d mortality and dialysis dependence rate in the high uNGAL group were significantly higher than those in the low uNGAL group (P<0.05). The patients in the high uNGAL group had less time without mechanical ventilation and less time out of ICU than those in the low uNGAL group (P<0.05). There was no statistically significant difference in mortality between the early CRRT group and the standard treatment group at 28 d. Days without mechanical ventilation and days without ICU stay in the early treatment group were significantly longer than those in the standard treatment group (P<0.05). The ratio of dialysis dependence was lower in the early CRRT group than in the standard treatment group, and the recovery rate of renal function was higher (P<0.05). In the early CRRT group, uNGAL showed a decreasing trend after treatment, which significantly decreased at 48 h (P<0.05). There was no significant difference between the uNGAL levels before and after treatment in the standard treatment group. The levels of IL-6 and TNF-α in the early CRRT group decreased 24 h after treatment, and further decreased 48 h (P<0.05). The levels of IL-6 and TNF-α showed no significant changes after the treatment in standard treatment group, but there were statistically significant changes in the uNGAL and IL-6 levels 48 h after the treatment in the two groups. Conclusion It is feasible to use uNGAL to classify patients with sepsis AKI and uNGALcan be a reliable indicator to guide the initiation of CRRT.