INTRODUCTION@#
Creatinine has limitations in identifying and predicting
acute kidney injury (AKI). Our study examined the utility of
neutrophil gelatinase-associated lipocalin (NGAL) in predicting AKI in
patients presenting to the
emergency department (ED), and in predicting the need for
renal replacement therapy (RRT), occurrence of
major adverse cardiac events (
MACE ) and all-cause
mortality at three months post visit.@*
METHODS @#This is a single-centre prospective
cohort study conducted at
Singapore General Hospital (SGH).
Patients presenting to SGH ED from July 2011 to August 2012 were recruited. They were
aged ≥21 years, with an estimated
glomerular filtration rate <60 mL/min/1.73 m2, and had congestive
cardiac failure ,
systemic inflammatory response syndrome or required
hospital admission. AKI was diagnosed by
researchers blinded to experimental measurements.
Serum NGAL was measured as a
point-of-care test .@*RESULTS@#A total of 784
patients were enrolled, of whom 107 (13.6%) had AKI. Mean
serum NGAL levels were raised (P < 0.001) in
patients with AKI (670.0 ± 431.9 ng/dL) compared with
patients without AKI (490.3 ± 391.6 ng/dL). The
sensitivity and specificity of NGAL levels >490 ng/dL for AKI were 59% (95%
confidence interval [CI] 49%-68%) and 65% (95% CI 61%-68%), respectively. Need for RRT increased 21% per 100 ng/dL increase in NGAL (P < 0.001), whereas odds of
death in three months increased 10% per 100 ng/dL increase in NGAL (P = 0.028). No clear relationship was observed between NGAL levels and
MACE .@*CONCLUSION@#
Serum NGAL identifies AKI and predicts three-month
mortality .