Análisis de la lipocalina asociada a la gelatinasa de neutrófilos en el paciente crítico / Analysis of neutrophil gelatinase-associated lipocalin in the critical patient

OBJETIVO: Determinar si un valor de NGAL > 150 ng/ml es una buena prueba diagnóstica para detectar precozmente disfunción renal aguda (DRA) en el paciente crítico. DISEÑO: Estudio prospectivo, observacional, de cohorte. Ámbito: Unidad de cuidados intensivos y de cirugía cardíaca del Servicio de Medicina Intensiva del Hospital Germans Trias I Pujol. PARTICIPANTES: Los pacientes ingresados en el Servicio de Medicina Intensiva los días designados en el estudio. INTERVENCIONES: Análisis sanguíneo de la creatinina sérica determinada desde siete días antes del día de inicio del estudio, y diariamente durante cuatro semanas. Determinación de NGAL mediante prueba de orina, en muestra congelada, con el analizador ARCHITECT (Abbott diagnostics)por inmunoanálisis determinado el día de inicio del estudio y dos veces a la semana durante cuatro semanas, análisis de la estancia y mortalidad. RESULTADOS: Se obtuvieron 529 muestras de NGAL de 46 pacientes. El 37% de los pacientes presentaron un valor de NGAL > 150 ng/ml. La sensibilidad de la prueba para diagnosticar DRA fue del 69%, la especificidad fue del 75,7%. Sin embargo, el valor predictivo positivo fue del53%, lo cual significa que el 47% de los pacientes con NGAL alto no desarrollaron DRA. Un NGAL > 150 mg/dL se asoció de manera significativa a un SOFA más alto y a una estancia más larga en UCI. La mortalidad de los pacientes con NGAL elevado fue del 58,8%. CONCLUSIONES: Un NGAL > 150 ng/mL no parece ser una excelente prueba para detectar DRA enel paciente crítico pero si que se asocia con un peor pronóstico

OBJECTIVE: To determine if NGAL value exceeding 150 ng/mL is a good diagnostic test for acuterenal failure in critically ill patients. DESIGN: Prospective, observational cohort. SETTING: Intensive Care Unit and Cardiac Surgery Intensive Care Service at Hospital Germans Trias I Pujol. PARTICIPANTS: Patients admitted to the Intensive Care department the Designated days in the studio. INTERVENTIONS: Analysis of serum creatinine blood given from 7 days prior to the start of the study, and daily during 4 weeks and by determination of NGAL urine test in frozen sample, analyzer ARCHITECT (Abbott Diagnostics) determined by immunoassay the day baseline and 2 times a week for 4 weeks, analysis of the stay and mortality. RESULTS: A total of 529 NGAL samples were obtained from 46 patients. 37% of patients had a value of NGAL > 150 ng/mL. The Sensivity of the test to diagnose acute renal failure was 69%, Specifity was 75,7%. However, the Positive Predictive Test Value was 53%, which means that47% of patients with high NGAL did not develop AKI. A NGAL > 150 mg/dL was associated with a significantly higher SOFA and a longer stay in the ICU. The mortality of patients with elevated NGAL was 58.8%. CONCLUSIONS: A NGAL > 150 ng/mL does not seem to be an excellent test for AKI in critically lll patients but is associated with a worse prognosis

[Analysis of neutrophil gelatinase-associated lipocalin in the critical patient]. / Análisis de la lipocalina asociada a la gelatinasa de neutrófilos en el paciente crítico.

OBJECTIVE: To determine if NGAL value exceeding 150 ng/mL is a good diagnostic test for acute renal failure in critically ill patients. DESIGN: Prospective, observational cohort. SETTING: Intensive Care Unit and Cardiac Surgery Intensive Care Service at Hospital Germans Trias I Pujol. PARTICIPANTS: Patients admitted to the Intensive Care department the Designated days in the studio. INTERVENTIONS: Analysis of serum creatinine blood given from 7 days prior to the start of the study, and daily during 4 weeks and by determination of NGAL urine test in frozen sample, analyzer ARCHITECT (Abbott Diagnostics) determined by immunoassay the day baseline and 2 times a week for 4 weeks, analysis of the stay and mortality. RESULTS: A total of 529 NGAL samples were obtained from 46 patients. 37% of patients had a value of NGAL>150 ng/mL. The Sensivity of the test to diagnose acute renal failure was 69%, Specifity was 75,7%. However, the Positive Predictive Test Value was 53%, which means that 47% of patients with high NGAL did not develop AKI. A NGAL >150 mg/dL was associated with a significantly higher SOFA and a longer stay in the ICU. The mortality of patients with elevated NGAL was 58.8%. CONCLUSIONS: A NGAL>150 ng/mL does not seem to be an excellent test for AKI in critically ill patients but is associated with a worse prognosis.